Preamble

The House met at half-past Nine o'clock

PRAYERS

[MR. SPEAKER in the Chair]

Motion made, and Question proposed, That this House do now adjourn.—[Mr. John M. Taylor.]

AIDS

[Relevant documents: Third Report from the Social Services Committee on Problems Associated with AIDS, House of Commons Paper No. 182-I of Session 1986–87, and the Government responses to that Report, Cm. 297.]

The Minister of State, Department of Health (Mr. David Mellor): This is the first time that the House has had a full debate on AIDS since November 1986. I suspect that I shall not be alone in welcoming the opportunity that the debate presents for me to update the House on such recent advances as have been made in the knowledge of the disease and to listen to views on a matter in which I know Members on both sides of the House have taken a real interest. In particular, we shall want to consider, in as much detail as time permits, the threat that AIDS poses to public health and to analyse the action that the Government and other authorities are taking to meet that threat.
It had been the intention of my hon. Friend the Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), to be present for the debate and to make a contribution at the end of it. There is a significant Scottish dimension to the issue. I know that a number of Scottish Members wish to take part in the debate. Sadly, my hon. Friend has had a bereavement and has to attend a funeral today. That is why he is not here. If, therefore, I am able to catch your eye, Madam Deputy Speaker, I may have to subject the House to a second dose of me. I regret that; I had not intended that that should be so. I shall try to deal with Scottish points, but I assure the House that any points with which I do. not deal will be dealt with in correspondence by my hon. Friend. I know that the House will understand his reasons for not being here.
Since we last discussed the matter in 1986, all of us have heard a great deal more about AIDS and HIV infection. The initial impact on the public of the existence of this disease and the threat that it posed was very striking. The date of 1 December 1988 was designated World AIDS Day. It gave us all a further chance to refocus our attention on AIDS and to prevent increasing familiarity with the disease breeding indifference. However, there is a danger that as AIDS becomes an accepted fact of everyday life it will lose its impact.
Preventing the spread of AIDS depends crucially on people changing behaviour that puts them at risk. That will not happen if people become complacent. We must not lose, therefore, the momentum generated by the public education campaign that the Government have sought to sponsor with vigour, by the many contributions to the

debate in the media, and by the efforts of those who are working in this area to ensure that proper attention is focused on the disease. We must not relax our attention or lessen our commitment.
Once again, let me say how much I welcome the debate. In some ways it is perhaps an overdue opportunity for hon. Members on both sides of the House to reiterate their collective awareness of the disease and their willingness to join in a sensible and, I trust, non-partisan way in devising effective strategies against it. When I was responsible for the Government's policy on drugs a few years ago I always said that there was no monopoly of wisdom in any part of the House on the issue; all of us have a contribution to make. Hon. Members know that their contributions will be treated seriously and that, where appropriate, they will be acted upon.
I have happy memories of the Drug Trafficking Offences Act 1986, which was passed after a great deal of discussion between Front-Bench Members. It had the support of both sides of the House. The Act has had considerable success in ensuring a flow of information from financial institutions about suspected drug trafficking transactions. It has also helped to ensure that there is a formidable further disincentive to drug trafficking—not just heavy prison sentences but the confiscation of the proceeds of drug trafficking by what remains one of the most forthright legal procedures anywhere in the world. I hope that that kind of spirit will imbue this debate. Certainly it is the spirit in which I am approaching the debate, together with a willingness to listen to and to learn from each contribution.
I first became aware of AIDS when dealing with the drugs issue. Since returning to such topics on becoming Minister for health matters in July, I have sought to update and deepen my awareness of AIDS. I have visited St. Stephen's hospital, the National AIDS Helpline, the London Lighthouse, the Terrence Higgins Trust and other major facilities throughout the country and have attended major functions arranged by the National AIDS Trust and others. I have been greatly impressed and encouraged by the commitment and skills of the people whom I met. Inevitably, though, the recital of the facts of this disease, and personal witness of the suffering it causes, has been a sobering experience for me. On that basis, I want to give the House some account now of the situation as I see it, before listening with care to what other hon. Members say.
Our knowledge about HIV and AIDS has greatly increased since November 1986. We now have much more epidemiological information, and more is known about the clinical course of the disease. There have been movements forward in treatment. For example, the drug zidovudine—or AZT as it is more generally known—was licensed in March 1987. That and other things have improved the treatment and management of opportunist infections and cancers associated with AIDS. However, those are palliatives and, although they have improved, I fear that the plain truth is that we are no nearer either to a cure in the generally accepted sense of the word or to the vaccine on which so many pinned their hopes in the earlier days of the epidemic. I am advised that the chances of a breakthrough on developing a vaccine in the near future remain very small. The only certain protection against AIDS is not to get the virus in the first place. None of us can stress that too often.
Something else that has changed throughout the period, and worryingly so, is the fact that the predictions


about the proportion of people infected with HIV who will go on to develop AIDS or AIDS-related conditions have become markedly more pessimistic. Five years ago I remember being told that somebody infected with the AIDS virus had a one in 10 chance of developing the disease. Two years ago—about the time that the House was having its last debate on this subject—information suggested a 30 per cent. chance. The latest evidence now suggests that at least 80 per cent. of those people infected with HIV may eventually go on to develop AIDS. Some experts are even more pessimistic than that. That is a sobering and troubling development.
Expanding our focus to the world, the picture is grim. The virus continues to spread and the World Health Organisation, with which, as the House knows, we keep in the closest touch and consider ourselves to be one of its more active members in relation to this topic, now estimates that between 5 million and 10 million people worldwide are already affected by the virus. Furthermore, although the numbers of reported cases of AIDS known to the World Health Organisation are only 130,000, it is estimated that the true figure is likely to be over 350,000. The World Health Organisation predicts that during 1989 and 1990 more than 400,000 new AIDS cases will occur worldwide.
Against that background, we in the United Kingdom have sought to develop effective policies. We believe that clear and determined action is needed in response to the challenge posed to our society by the virus and AIDS. We have a four-part strategy to achieve that, consisting of public education; infection control and surveillance; research; and the development of care and treatment services. That strategy is backed by a strong commitment to international co-operation to combat the disease.
Before saying a little more about Government action to open the way to the advice that I know will be given by colleagues about what else we can do, I should like to make it clear once again that we are all on a learning curve in this matter. None of us should hesitate to put forward new ideas, because in the end our only defence against AIDS is the generation of new ideas.
I shall now set out the factual background of my understanding of the extent of AIDS infection in this country. Our surveillance systems show that at the end of last year in the United Kingdom 1,982 people were reported as having AIDS, of whom 1,059 had died. Also at the end of December, just over 9,600 people had been found to be HIV positive. As I shall mention in a moment, those figures undoubtedly underestimate the true number of people who have become infected. We passed our first sombre milestone in October 1988 when deaths passed 1,000. We are just about to pass—I suspect this month —the figure of 2,000 reported AIDS cases. I fear that, alas, there will be many more such milestones.
One of the great uncertainties has always been accurately predicting the likely future spread of the disease. That is why my predecessor, my right hon. Friend the Member for Braintree (Mr. Newton), asked an expert group under the chairmanship of Sir David Cox, the distinguished statistician, to make predictions of the number of cases of AIDS which are likely to occur in England and Wales in the next two to five years. As the House knows, the group's report was published at the end

of November 1988 and concluded between between 10,000 and 30,000 cases of AIDS are likely to be diagnosed in England and Wales by 1992. It recommended a figure of 13,000 cases as the basis for planning. By the end of 1992 the report estimated that between 7,500 and 17,000 people are expected to have died from AIDS. Those figures are lower than earlier estimates and reflect the welcome fact that the rate of increase of new AIDS cases has been slower than some once thought, largely we think due to changes in the behaviour of homosexual men several years ago when that community became aware of the AIDS threat. The report also estimated that by the end of 1987 there were between 20,000 and 50,000 people infected with HIV, compared with the 9,500 reported under the reporting system at the end of December 1988. Hence our concern that the official figures will always be an underestimate for a whole range of reasons with which the House is familiar.
We have accepted the Cox report as the best basis we have for future planning. We hope, having established the data base, to update and republish figures annually. I hope that that will be seen as a useful step forward. We took the opportunity at the end of last year to announce further improvements in the monitoring and surveillance of HIV infection and hope therefore to be able to narrow some of the ranges of prediction as we get better data and as our experience grows.
Before leaving the Cox report, I should say that it makes several important points that we should not forget. First, it makes it fundamentally clear to sensible folk how serious a problem we face in this country from AIDS.
Those who inject drugs and share equipment are putting themselves at possibly the highest risk. There is no great evidence that drug users are heeding the warnings and changing their behaviour. I know the concern about that in some Scottish cities. However, drug users need to change their behaviour. Professor Cox suggests that HIV infection amongst drug users in England and Wales could give rise to 1,000 AIDS cases by the end of 1992 and warns that a large scale epidemic among that group could lead to a rapid rise in the numbers of new cases. We must always remember that that group is a bridgehead into the wider community, being predominantly heterosexual in orientation. The tragedies that then unfold, with sexual partners and babies being infected, is alas becoming not unfamiliar in some of our cities. We must recognise the extent of the threat from that quarter.
As I said earlier, there is welcome evidence that many homosexual men have been heeding the warnings and changing their lifestyles to protect themselves and others against infection. I welcome that, too. It shows clearly that the one truth that we must never lose sight of, perhaps the one ray of light in what is otherwise a rather dark picture, is that there is nothing inevitable about the spread of HIV. It all depends on how we respond to a common-sense message. As the homosexual community is showing, the rate of spread of infection can be reduced by changes in personal behaviour. But all this depends on not dropping our guard. Sir David Cox says:
It would be a gross error to regard even the lower predictions as grounds for complacency".
I wholeheartedly endorse that sentiment. Behavioural changes amongst homosexual men need to be sustained. Heterosexuals need to recognise that, while there is a small risk of catching HIV in Britain today, it could become much greater in future if the warnings are not heeded. The potential threat is serious, especially for those who change


partners frequently or who get conditions which cause genital ulcers, and possibly other sexually-transmitted diseases. The evidence from overseas—and especially from Africa—indicates the seriousness of the risks of heterosexual HIV infection. Coming much closer to home, the proportion of AIDS cases thought to be the result of heterosexual contact is at least twice as much in France as in this country so far; and in several other European countries such as Belgium it is higher still.
The writing is on the wall. We should be sure to read it. Perhaps it would be helpful if I said a little more about heterosexual spread. I am advised that heterosexual transmission of HIV is a complex matter which we do not yet fully understand. It is not clear why the facility of transmission between heterosexual people in central Africa is so much greater than within, for example, New York city where the virus has been well established among heterosexual drug misusers, including many prostitutes, for at least 10 years. That is an extremely important gap in our knowledge. There is some evidence that the higher prevalence of conditions which cause genital ulcers may be a factor, but it is probably not the only one.
AIDS is a developing problem about which our knowledge is constantly changing. When we look at the proportion of those with HIV who are likely to go on to develop AIDS, and in the absence at this time of clear data on infection via heterosexual contact, it becomes clear that we all must be cautious, especially as we know that a single act of unprotected vaginal intercourse can spread the infection. AIDS is a sustained and growing threat and people should not take false comfort from the current low rates of heterosexual spread in the United Kingdom or the differences in rates of spread abroad. Where uncertainty exists, the prudent err on the side of caution, especially when, as I have already made clear, most of what we have learnt in recent time about the disease makes it seem even more serious than was once thought rather than less so. There is no room for false comfort.
On that basis, I have to say that there is potential for the spread of the infection throughout the population and we cannot ignore that. Yet there are few signs that heterosexuals and drug users are changing risky behaviour to protect themselves. But protect themselves they must.
In trying to assess the extent of the disease, we thought it necessary in November to improve our monitoring and surveillance system. In doing so, we were greatly assisted by the recommendations of an expert group chaired by Dr. Joe Smith, director of the public health laboratory service. I should like to emphasise the care we try to take in obtaining and assessing expert advice before taking any initiative in what is a difficult and complex field.
We have asked the Medical Research Council to draw up, by the end of February, detailed proposals for a comprehensive programme of surveillance studies. Those studies will be designed to give us better information about how the epidemic is developing both in the general population and in those specific groups that are or may be at risk. They will include studies based on anonymous testing, that is, the testing of blood samples taken for other purposes in a way which preserves the total anonymity of the donor.
Those studies will be in addition to the surveys of pregnant women which the MRC has recently begun in Edinburgh and Dundee, as well as studies of other groups such as those who attend drug misuse services and sexually-transmitted disease clinics.
I am glad that the number of those who expressed reservations about anonymous testing has been less than some initially thought. Such worries as there have been have centred on the impossibility of informing and advising those who prove to be HIV positive. I should emphasise that the purpose of these anonymous tests is to obtain general prevalence data, not to make clinical diagnoses, and this is, in our view, the only way in which this can sensibly be done. But anyone who wants to have a named test can have one, and any doctor who thinks that a named test might be in the best interests of a patient can offer one free. Therefore, anonymous surveillance testing is in a category of its own and does not affect people's rights to know whether they have the virus and have their minds put at rest if they think that they may be carrying it. That is a crucial point.
Anonymous testing will provide valuable information about the prevalence of HIV infection by age and sex in various parts of the country and the rate at which it is spreading in the population.

Mr. Toby Jessel: Is my hon. and learned Friend saying that if an anonymous test takes place and a person is found to be infected there is no way in which the doctor handling the test and the patient can be informed that his blood is infected, and, if not, why not?

Mr. Mellor: I have already sought to explain the matter. The basis of anonymous testing is that, when the AIDS test is given, a sample will have been taken for a completely different purpose and will have been anonymised. If people feel that they may have had a chance of contracting the virus, they can go to their doctor and, with proper counselling, have a test. But the purpose of anonymous testing is to discover how far the virus has spread into the broader community. We cannot have anonymous testing yet have the ability to tell someone, "I am afraid that your blood is positive." However, that is in addition to all the other measures we are taking to ensure that no one need be in any doubt. It is not as if we are withdrawing from any of the arrangements that have already been introduced.
I hope that most hon. Members will agree that the general public are not preoccupied by the ethics of what we are proposing. They would be much more troubled if they felt that we had shied away from taking the necessary steps to get an accurate measure of the problems we face.
I am anxious not to outstay my welcome, but equally I am anxious to give the House the best possible account of where we stand as perceived from my Department, so I shall turn to other aspects of our strategy, particularly public information.

Mr. Tim Rathbone: There was a worrying report in this morning's papers that the Soviet Union would require testing and a negative result for all those visiting the Soviet Union for longer than four months. Has my hon. and learned Friend considered what that could lead to? It breaks through the principle of anonymity and raises the incredibly complicated question of the social drawbacks of individual testing. Although I do not expect that my hon. and learned Friend has had a chance to consider that information since it was published, I hope that he will look into it.

Mr. Mellor: We have sought to prevent a lot of arbitrary barriers to the free passage of people being put


up around the world. Given the complications of AIDS tests, the time lag between getting the virus and the antibodies showing up, the difficulties of the test itself, which has a number of faults, and the problem that in some countries having a test puts people at some health risk as a result of some of the equipment used, we are very sceptical of such unilateral initiatives. Although it is not a matter for me, I suspect that there will be those elsewhere in government who may wish to make representations about the matter. We have sought to avoid unilateral acts by countries that, in my judgment, simply make the problem more difficult to deal with. Arbitrary barriers to travellers offer totally illusory protection against a disease that I suspect we shall have to combat in other ways.
Turning to the question of public education, I believe that we have taken some measures that we can be proud of to slow down the epidemic and prevent its spread. The Government have spent more than £20 million since March 1986 on the biggest ever campaign of public education on a health issue. Follow-up research has shown that it has greatly increased awareness of HIV and AIDS and public understanding of how it is and is not spread. It is just as important that people should know how it is not spread as how it is spread. We want to avoid problems in the workplace and some of the happenings in the United States. I remember one youngster in the United States who acquired the virus from a blood transfusion and was treated most disgracefully at his school. People must know how they can contract the disease, and equally they must know how they cannot.
Politicians are not always grateful to the media, but I am. The media have played their part in ensuring that a wide range of facts about AIDS have come forward, not all of which have been entirely accurate although much has, and that has been most welcome.
We are now at a critical point. The initial impact has begun to wear off and apathy must not rule. Familiarity must not breed indifference. That is why we look to the Health Education Authority, in association with health education agencies in Scotland, Wales and Northern Ireland, to carry forward the development of a United Kingdom-wide public education campaign. We hope that the Health Education Authority will be able to develop strategies that will command the support of all hon. Members. The aim is to ensure that the policies could be conceived outside the Government machine to avoid any mix-up of criticism of the Government with criticisms of the campaign. I hope that everyone will lend their support to the campaign.
The HEA launched a new campaign just before Christmas with three aims: to influence behaviour among young sexually active people; to encourage people to act responsibly with regard to their sexual behaviour; and to provide information that people need to protect themselves and those close to them. All the material will be evaluated by independent researchers to see what happens.
I believe that the campaign so far has received widespread public support. However, it needs to be backed by initiatives targeted at particular sections of the population. I attach special importance to giving youngsters inside and outside school the facts about AIDS

and a healthy lifestyle. That is a key part of preparing them for some of the difficult choices that they will have to make in future.
Just before Christmas, we launched the latest phase of the Government's anti-drug campaign which focused on the dangers of injecting drugs. I hope that the vividness of those advertisements has struck a chord with my colleagues. We will continue to tackle the problem of drug misuse with the greatest determination because the fewer injecting drug misusers there are the smaller will be the chance of HIV spread among them and from them into the wider community. Of course, we must be realistic. Some people will continue to misuse drugs. If they are not immediately willing or able to stop, we must ensure that they are helped to reduce the risk of infecting themselves or others.
We believe that many initiatives must be local. That is why we have asked every health authority in England to work with local authorities and the voluntary sector to develop local community-based initiatives aimed at dealing with the problem in their neighbourhoods. We have announced £14 million worth of new money for schemes next year, and some funds have been made available immediately so that staff can be recruited or redeployed at regional level to begin the necessary planning. Each district will be expected to nominate an office responsible for the planning and co-ordination of that work.
It is no good expecting people to change their behaviour if we cannot prevent the spread of infection in health care or other settings. Obviously there are few more deeply distressing problems that we must come to grips with than the spread of AIDS to people who have used factor 8 and similar preparations. We have taken measures since that tragedy to protect the blood supply and tissues and organs donated from transplantation, and we have asked health authorities to improve their infection control. We believe that infection through blood transfusion in this country is now virtually non-existent. Of course, there is no risk whatsoever from donating blood. Information pamphlets have been directed to other groups such as tattooists and ear piercers so that they can take steps to prevent HIV spreading.
I want now to refer to service development and the money that will be available next year. We made £25 million available in the last financial year and nearly £62 million this year, and nearly £130 million will be available next year. That is the scale of the increases that we think it is appropriate to make to combat the problem.
We are giving money to local authorities to encourage services in the community, and a circular is being issued today inviting each local authority in England to bid for a share of £7 million available for AIDS-related social services expenditure with grants on the usual 70 per cent. basis, with local authorities meeting 30 per cent. of the costs from their general revenue. The money will be targeted particularly on the 25 local authorities which currently face the greatest AIDS-related demand.
We have told regional authorities how we intend to disperse the remainder of the £130 million. North West Thames regional health authority will continue to receive the lion's share—more than £36 million—because it has nearly 800 AIDS patients already. The other 11 regions will receive allocations as best as we can grant them which best reflects the problem in their own communities. We are


also including a substantial new element, not just to treat AIDS patients, but to build up services which play a crucial role in preventing the spread of HIV.
I expect that at least £68 million will be spent on providing services for people with HIV infection and AIDS. Of the remainder, more than £50 million, I expect health authorities to build up services to prevent the spread of HIV by spending money on local prevention initiatives, genito-urinary medical services and drug misuse services. We are talking about quite substantial sums of money, I am glad to say.
We know the extent of the drugs problem. It is not simply a Scottish problem as 26 per cent. of those tested at the St. Stephens drug dependency unit have proved seropositive. The disease is spreading. We established 14 experimental needle exchange schemes in England and there are now 60 schemes in all the country. If injectors cannot be persuaded to stop, in the interests of individual and public health we must do everything possible to stop them sharing.
Hon. Members may have noticed that the final report from the research team evaluating the needle schemes was published yesterday. It shows that schemes are quite successful at attracting injectors, although not perhaps so good at keeping them in regular contact. They are attracting people who otherwise would not have contacted drug services and they are helping some people to stop or reduce sharing.
As someone who was very much in favour of those experimental schemes during my time at the Home Office, I am glad to see that the researcher considers that, although the schemes have limitations, they can potentially make an important contribution to preventing the spread of infection. We are considering the report to see what more we need to do, and I dare say that my colleagues will want to comment on it because, in the past, the policy, although I believe the right one, has been controversial.
We also want to expand accessible advice and treatment services where drug misusers can receive help with their drug problem and reducing their risk of contracting HIV. Substantial additional resources both north and south of the border have been made available for that this year.
We are particularly asking health authorities this year to strengthen their genito-urinary medicine services. That is the term given to the old VD clinic, the Cinderella service in so many hospitals. We believe that Cinderella must be put behind us because those services have a vital role to play in combating the spread of HIV and AIDS. Their clients include many people who are most at risk because their behaviour has led to sexually-transmitted diseases and because of the evidence that I have already mentioned that the transmission of HIV is more likely to take place if people are infected with some sexually-transmitted diseases.
We must remember that, in the past five years, some 2 million people contacted genito-urinary medicine clinics, so we are not talking about a small number of people. The workload has been rising significantly. It is a crucial service and it is under pressure. However, it should not be hidden away in places that might not be seen by patients as attractive places to visit or by staff as good places in which to work. In order to assess whether the clinics are playing a key role, the chief medical officer asked a small team to carry out a study of the current and forecast workload. The report has now been received and makes specific

recommendations about resources, siting, quality of accommodation, manpower and training of staff The recommendations show that health authorities will need to give much higher priority to the services. We accept that, and I am pleased to be able to say that we look to the health authorities to take full account of the report in using the new resources that have been made available. The services need to be improved to benefit those who use them now and in the future.
I am sorry if I have spoken for a long time because I know that many of my colleagues want to speak. However, there are many other points that I could make. In conclusion, I want to draw attention to the work of the Overseas Development Administration. It has committed over £16·5 million, through the World Health Organisation, other non-governmental organisations and research workers, to support programmes to help to understand and contain the spread of AIDS in developing countries.
International co-operation on AIDS is not optional; it is a necessity, as it is in many other areas. That is why the Government and, I am sure, the House, are pleased that last year we sponsored, with the WHO, a world summit of Health Ministers on programmes for AIDS prevention. We want to continue to take the lead in that.
I look forward to hearing the views of hon. Members. I hope that what I have said establishes some new points which may be helpful to my colleagues when shaping their contributions. The Government have tried to take the lead in publicising the threat of AIDS and helping the development of services to combat it. Obviously, there is a limit to what the Government alone can do, and it is only by continuing to work with the voluntary bodies, local authorities and so on and by individuals taking personal responsibility that we shall make progress in defeating AIDS.
If two years ago the message was, "Don't die of ignorance", today our message is, "Now you know the facts, act upon them".

Ms. Harriet Harman: I welcome this opportunity to debate such an important issue and I thank the Select Committee on Social Services for the report it produced in 1987 which stressed that we need regular debates on AIDS.
The Minister has given the House the benefit of a useful description of the spread of AIDS. However, preventive and community services remain inadequate in most areas and non-existent in some. Unless we prepare a network of support services, including housing—which I was sorry that the Minister did not even mention—we shall inevitably drift towards the situation that now exists in the United States where AIDS sufferers are dying on the streets.
The Government must sharpen their approach to education on AIDS. The increase in AIDS among young people means that conveying the message to school children is especially important. The Government have made that more difficult in two ways. First they have allowed schools to opt out of providing sex education to pupils and, secondly, they have made it more difficult to discuss anything to do with homosexuality by passing section 28 of the Local Government Act 1988.
I should like to put into context the sums of money announced by the Minister. Michael Adler, professor of genito-urinary medicine at Middlesex school of medicine, estimates that, up to 1992, cumulative costs of AIDS to the health services will be between £134 million and £1·4 billion. As the Minister said, the pivotal services are genito-urinary medicine, drug dependency services and community services, which are now and have been for many years, underfunded—Cinderella services. Therefore, we are building from an underfunded and inadequate base.
We cannot meet the unprecedented public health challenges that AIDS presents if we drip-feed small sums into the system. We need to plough into the infrastructure, especially into the services that I have mentioned, substantial sums which must not be clawed back from other services. I hope that the Minister will guarantee that the sums he mentioned today will be fresh money from the Treasury and not snatched from somewhere else in the Health Service.
The Minister said, and I welcome it, that he recognises that the problem of AIDS relates to men and women, and that heterosexual transmission is likely to spread the problem to all regions. I should like to draw the attention of the House to a plan produced in an article in the British Medical Journal which shows that 44 Edinburgh drug users who attended the city clinic then shared needles in different parts of the country. They went to Oxford, Bristol, London, Cambridge, Newcastle and Manchester. Therefore, there are no departmental boundaries between Scotland and England, Wales and Northern Ireland. It must be recognised that the disease will spread into all regions and we must plan and prepare on that basis.
The Health Education Authority has been charged with trying to convey the message, particularly the threat to heterosexuals. I hope that the Government and the Minister will reinforce that message by constantly contradicting reports which still appear in newspapers that stress that this is a problem only for drug abusers in Edinburgh or gay men in London. I bring to the Minister's attention an article in The Sun on 20 October 1987 written by the paper's supposed medical adviser. I give the Minister an opportunity to say that he disagrees with it. It says:
The only people really at risk are promiscuous homosexuals and drug addicts.
The DHSS and the BMA have drummed up hysterical campaigns designed to scare heterosexuals and put us all off sex. But the facts show that they were wrong.
I hope that the Minister will say that such reports are not only wrong but dangerous. The fact that AIDS is likely to spread to all regions means that we must have a finely tuned and sensible regional distribution of funds. Will the Minister explain the regional distribution of funds? The figures that I shall give to the House were presented by Professor Maynard, director of the centre for health economics at York university. He has calculated how much each region has received per AIDS case. The northern region received £59,500 per AIDS case as at August 1988, Yorkshire region received £52,500, Trent £58,000, East Anglia £75,000, North West Thames £74,500, North East Thames £79,500, South East Thames £60,000, South West Thames £53,000, Wessex £62,000,

Oxford £72,500, South Western £30,000, West Midlands £42,000, Mersey £49,500, North Western £50,000 and Lothian £20,000.
We must have an explanation of the regional disparity in the allocation per AIDS case. One per cent. of all men in Lothian between the ages of 15 and 45—not just drug abusers or gay men—are already HIV positive. That is why, unfortunately, Edinburgh has been called the AIDS capital of Europe. It is hard to understand why Lothian should receive one quarter of the amount received by one London region. Either there has been some awful error, which the Government must undertake to put right, or there is a more sinister motive. I hope that it has been an error and that the Government will announce that they intend to correct that inequity of distribution.

Mr. Jessel: Is the hon. Lady aware that some people who are infected and who need treatment for the disease will come into regions such as North West Thames, which covers the centre of London, to obtain treatment? There is, therefore, not only the cost of that treatment, but the cost of treatment for patients suffering from other illnesses and who need operations, who might otherwise be displaced. Why should not authorities such as North West Thames have a larger share per case of available resources?

Ms. Harman: I am not criticising the levels in the London regions, but the low level put into other regions, particularly Lothian. The argument that was put so cogently by the hon. Member for Twickenham (Mr. Jessel) about people coming into city centres when the problem is discovered applies to Edinburgh as well.
Either the Government must correct their mistake or there is a more sinister motive underlying the imbalance. I have listened time and time again in the House to Ministers complaining about the amount spent on health services in Scotland. When I saw the figures, it occurred to me that the Government might be trying to level down health spending in Scotland at the expense of AIDS patients. If the Minister has another, innocent explanation, such as that a mistake has been made that he would like to put right, I hope that he will say that to the House. I hope that he will not submit to the temptation to rubbish the figures or to say that he does not know about them. The figures were given by Professor Maynard at a conference at which the Minister himself spoke, so if he does not know about the figures it can only be because he did not listen to the other speeches.

Mr. Mellor: I am sorry to hear the hon. Lady playing to the Scottish gallery and making essentially spurious points. I shall ensure that the hon. Lady is advised by the Scottish Office about the details. She would be the first to complain if English Ministers were responsible for running policy for Scotland. A substantial amount of resources are available in Scotland. The hon. Lady should bear in mind one figure that appears to have escaped her. I said nothing to imply that I underestimated the size of the problem in Scotland. The problem there is large, and requires a large amount of effort to be devoted to drug-related issues. However, as of December, the number of full-blown AIDS cases for the National Health Service to treat in the whole of Scotland was 75. In the North West Thames Region alone, there were nearly 800. I should have thought that she would see that one does not have to reach for McCarthyite explanations to see why that amount goes to the North West Thames Region.

Ms. Harman: I gave figures not for the total amount for each region, but for the amount per AIDS case for each region. It is a pity that the Minister has accused me of playing to the Scottish gallery in expressing that concern. The health problem of HIV and AIDS in Scotland is a problem not only for Scotland, but for the rest of the United Kingdom, because of the transmission of the disease, which I have previously explained. I await, with interest, a further explanation from the Minister. I am not the only person to be concerned. My concern is prevalent among those who are involved with AIDS and AIDS services in the country as a whole.
I welcome the emphasis that the Minister said that he placed on education, and sex education especially, because, as he said, we are no nearer to a cure. He also said plainly and straightforwardly that youngsters must have the facts about AIDS, and I endorse that fully. With the spread of the disease among young people, the message for school children is especially vital.
I endorse wholeheartedly the Social Services Select Committee report on AIDS. It said that sex education and education about AIDS must be given to all school children. Yet the Government introduced the Education (No. 2) Act 1986 to allow schools to opt out of providing sex education. It is extraordinary that at a time when sex education and public health education about sex have never been more needed by school children the Government have provided an opportunity for such education to disappear from the curriculum.
I hope that the Minister, who is charged with dealing with the spread of AIDS, will agree that that is disastrous. Will he monitor the situation? I should like to know how many schools are opting out of providing sex education in the curriculum and, of those schools that are providing it, how many are informing the pupils about AIDS. The Minister needs to do more than simply endorse such education; he must find out what is happening in schools. It is not enough simply to quote, as he has in the past, the number of education authorities that have appointed AIDS officers. We need to know the number of school children who are receiving the AIDS message. I hope that he will confirm to the House that, if it is discovered that many schools are opting out of sex education and that a significant number of school children are missing the message, he will reconsider, with his colleagues in the Department of Education, the provision that allows schools to opt out of sex education.
The climate that has been generated by section 28 makes the task of reaching school children with such information more difficult. Those who work in schools fear that it will be difficult to find the dividing line between explaining about safe sex and promoting homosexuality. Perhaps the Minister can tell us, using examples, what the dividing line is between describing safe sex and promoting homosexuality. It would be useful for him to take the opportunity to make that clear and to reassure those who feel that they are under the shadow of section 28.
Another arm of prevention that is being directly undermined by Government policies is the family planning services, which are being cut. Those services have, for many years, played an important role in sex education, dealing with sexually transmitted diseases and providing public health information. Many women will not go to their general practitioners to discuss sexual matters or are not registered with a GP, and that is particularly the case among drug addicts, although many of them find their way

to family planning clinics. The financial squeeze on district health authorities has been so great that many are cutting family planning services.
The Family Planning Association has said that 25 per cent. of all district health authorities have made cuts in the past four years or are planning them. In the past week, three district health authorities—North East Essex, Hampstead, and Barking, Havering and Brentwood—have proposed 50 per cent. cuts in family planning services. I hope that the Minister will acknowledge that this is the wrong time to be cutting family planning services because we should be looking to them to play an enhanced role in the fight against AIDS. I hope that the Minister will take the opportunity to stress the importance of family planning services and that he will undertake to reverse those cuts.
I welcome the fact that the Minister mentioned needle exchange schemes, but I should have liked him to go further and to recognise that experiments with needle exchange schemes show that it is imperative that such schemes are widespread. Such schemes remain limited and patchy at present and I hope that the Minister will ensure that GPs become part of needle exchange schemes. That must mean that all GPs should be prepared to care for patients with HIV or AIDS and that needle exchange schemes must be in places and operate at times that are most convenient to intravenous drug users.
It is hard to overstate the importance of care in the community in relation to this issue. After the diagnosis of AIDS, the average time spent by a person in hospital is 20 per cent. compared with 80 per cent. in the community. A study by the Polytechnic of the South Bank has shown that fewer than 5 per cent. of people with AIDS are cared for by the family because of the way in which AIDS breaks up family ties and because of its prevalence in the gay community and among drug users. We have, therefore, an additional challenge to provide care in the community without a high level of family support. The Social Services Select Committee issued a strong warning about this, but I am sorry that it does not appear to have been heeded by the Minister.
In addition to meeting the needs of an ageing population, social services departments have to plan to provide care for a new group of people who need their services 20 to 30 years earlier than might have been expected. Community care will involve close liaison between health authorities and local authorities. It seems to me to be madness that, as we understand it the Government's review of the NHS, plans to take local authority representatives off district health authorities. When planning community care and the response to the growing number of people with AIDS, we should tighten the links between district health authorities and local authorities, not loosen them by taking off local authority representatives.
Because AIDS will affect all regions, all social services departments need to prepare. Preparedness is vital. The Government promised guidance about the development of local authority services, particularly social services, as long ago as April 1987, but it has yet to appear. I hope that the Minister will tell us when it will appear. I suggest that he uses the social services inspectorate. Care in the community will involve home care staff, training and recruiting new staff. The Minister should use the inspectorate to establish good practice and to develop it in all social services authorities.


The Minister should also ensure that social services departments have the resources necessary to develop the home care services which AIDS will demand. He has mentioned the £7 million, for part of which all social service authorities can apply. That figure is just a fraction of what the Government have taken away from my local authority—Southwark. The £7 million is derisory. If we are serious about care in the community, we need proper funding, not a pittance.
We also need more resources for the health part of community care. Health visitor posts in my district health authority have been frozen. How can that authority and health visitors play a part in developing services for people with AIDS when there are not enough in post to do the present job?
I should like all general practitioners to be trained. The British Medical Association has conducted a useful pilot scheme which should be taken up as a national initiative. We do not want GPs to have to learn by experience, at the expense of the first AIDS patients they see, how to provide decent care.
There was a note of complacency in the Government's mention of community services. I had the opportunity this week to talk to Joy Roulston, the director of the Abenour Trust project in Edinburgh. It took her three years to get funding for a project involving just six flats. We should remember that Edinburgh has been called the AIDS capital of Europe. She tried to establish a project involving just six flats for pregnant women—or women with small children—who have a drug problem. It is a short-term recovery unit for mothers and, helps to establish how the children are to be cared for. It is just the sort of community-based project helping with care and prevention on which the future strategy for dealing with AIDS depends. Despite the fact that she was in Edinburgh, it took three years to get funds for the project, although the project is excellent, she says that it is merely a drop in the ocean.
A new challenge is presented for social services departments by children who are HIV positive and—or have AIDS. We must have initiatives on fostering and adoption for the children whose mothers die. If we are not prepared we shall find ourselves in the situation which I saw in New York when I visited the city last year. A drug addict mother dies homeless on the streets and her child spends its entire life in a paediatric ward of a public hospital in New York. We must learn the lessons and prepare outselves with proper community care for mothers and children.
Community care also depends on the community's preparedness to care. The community will not be prepared to care if it is poisoned by prejudice. The Government should take a lead in speaking out against those, especially in the press, who bask in AIDS hysteria. We cannot have community care and a witch hunt. The Government have to choose. I hope that they will put themselves firmly on the side of community care and speak out at every possible opportunity against the witch hunt. Sadly, I feel that the Government have fed the witch hunt through the climate generated by section 28 of the Local Government Act 1988.
I am sorry that the Government have not mentioned AIDS and housing. It is impossible to have home care

without a home. AIDS often means a notice to quit. People with AIDS suffer a serious problem of discrimination in housing. Most people with AIDS are young, and young people are least likely to have secure housing. Even if they have sufficient income, they are often discriminated against in applications for a mortgage.
I was told by a young man from Frontliners that young single people with AIDS are able to find a hostel place only until their disease becomes visible. As soon as it is visible, it represents a notice to quit, so even substandard hostel accommodation is no longer available.
It is important for people with HIV and-or AIDS to have good housing. Good housing and healthy living can lengthen the time between HIV infection and the onset of AIDS, and people with AIDS are prone to infection, so they obviously need a good diet. They need good housing. They are also likely to need adaptations to their homes.
Many people come to London, voting with their feet against the lack of services provided in their own regions, but when they arrive they find that they are homeless, that they have spent their money on travelling and that they have no friends. Michael Adler, the professor of genito-urinary medicine at the Middlesex hospital, has said:
I wonder whether the Department of the Environment has yet heard of AIDS.
That view is widely shared by doctors, local authorities and voluntary organisations. The Department of the Environment is failing to respond to the challenge of AIDS. The Government should take a lead in providing resources for housing for people with AIDS and in encouraging local authorities to create sheltered housing themselves and through voluntary organisations. The Government must ensure that they have the resources necessary to do that.
The Government must also spread good practice among local authorities and voluntary organisations on such issues as confidentiality and non-discrimination. I should like the Government to call in the building societies and get a bit of sense out of them in a fair allocation of mortgages for people who are HIV positive. We need a national housing initiative, as housing is an essential part of care in the community for people with AIDS. Without one, we shall end up with the situation that exists in New York, which I have described.
It is when public fear is at its greatest that human rights are most threatened. I should like the Government to take a lead and to announce that, through their strategic role in data collection as an employer and as a provider of housing and other services, they will guarantee privacy and freedom from discrimination for people with HIV. The Government are a signatory to the European convention on human rights, which guarantees privacy and freedom from discrimination. I should like the Government specifically to acknowledge that they will guarantee the entitlement to those rights of people with HIV.

Mr. Jessel: Is not the most important human right the right to stay alive? With that in view, surely the highest priority in regard to human rights is the need to stop the spread of infection?

Ms. Harman: I do not like competition between human rights. The hon. Gentleman identified an important right, but there is no contradiction between it and the human rights of those with HIV and AIDS.
I hope that the Minister will not brush aside my proposals. They reflect wide consensus outside the House. The Minister must resist the temptation, to which I am afraid he has sometimes fallen prey in the past, to write off as party political any proposal that he has not heard of or thought up. I hope that he will join me in recognising the urgent need for a strategy that reaches into all regions and covers prevention, treatment and care.

Mr. Charles Irving: In the 16 years in which I have served in the House I have not become renowned for paying compliments and tributes to Ministers, but, on this occasion, I make a heartfelt exception. I pay tribute to my hon. and learned Friend the Minister of State. Since he has been in office, I have watched his progress in dealing with this awful matter. He has been courageous and has done an enormous amount in his search for resources for which he has to fight every inch of the way. I am delighted to tell my hon. and learned Friend of my appreciation. The extra money is exremely welcome, but, unfortunately, it is evident that it will prove to be nothing like enough. There has been a slow spiral from the very beginning.
It is interesting that, although the Government's education programme may be criticised—every such programme is criticised—it has brought AIDS out of the closet and into public discussion. AIDS is no longer whispered about. The more openly AIDS is talked about and the more freely views are exchanged, the greater will be the likelihood that the powers that are available to us will be taken with renewed vigour. It is important that AIDS is discussed and given proper credence as the nation faces its most serious health threat for about 400 years.
Despite my initial praise for the Government, I must stress that much more needs to be done. The Minister recognised that fact. It is extraordinary that the nation has been riveted to the front-page treatment that has been accorded by the newspapers to the so-called health risks of salmonella. As genuine as the concern may be, it pales into insignificance when compared with the problems and difficulties of AIDS sufferers.
AIDS is a scourge of the medical world. It threatens civilised life as we know it. Men, women and children are affected every day. I accept the Minister's point that the Government cannot travel alone down that path, but they must face up to their responsibilities. A national system of free condoms and needles is essential to save those most at risk.
I suspect that AIDS is rampant in prisons. I have said that before, and I believe it to be so. Rightly or wrongly, those of us outside the Home Office with our feet on the ground accept that prisons are probably one of the most fertile AIDS breeding grounds. We cannot pretend that the problem is contained within the walls of any of our corrective institutions. There is a danger that, when inmates are released, they will unleash the disease on an unsuspecting heterosexual populaton. They may not even know that they have the disease.
I hope that the Home Office will take on board the more realistic approach that its chief medical officer has privately expressed to me and to other hon. Members who have been extremely concerned, which is that we should find some dignified way of issuing condoms. Such a system prevails in other countries.
Another distressing fact is that, on an issue of such national importance, one would have expected more than this select group of hon. Members in attendance. However, at least the nation can be sure that the cream are present.
I saw a report in The Guardian the other day about there being 10,000 HIV carriers in Britain. In a sense such figures are bunkum, because they tell us only of those who are actually known. The greatest difficulty is that nobody knows where the problem begins, where it ends, what resources will be needed, whether we will overprovide, or whether we will underprovide. Perhaps the Minister will allow me to express a note of appreciation to his Department and his colleagues who work on this sensitive issue. The figure of 10,000 is merely the tip of the iceberg. Nobody knows what horrifying situation may emerge. AIDS has claimed thousands of people who did not even know that they had contracted the disease. The first time we know about it is when they are virtually dead.
The issue is above party politics. I have visited several projects in the United States and here, just as the Minister has. On my last visit to New York, I was told that it is estimated that one in 60 children are born with the virus. That is a terrible figure, but we are still in the dark and have no idea of the true situation.
The picture in California is even more bleak. One in six children may die of AIDS before they are even old enough to go to secondary school. I have no way of knowing whether those figures are correct. Unless we take the lead, a holocaust will erupt. Thank God a vital start has at least been made. The Minister has paved the way for a health education programme.
My local authority has taken an early lead. Cheltenham borough council has paid for the first mobile AIDS education caravan. I pay tribute to the chief environmental health officer, Clifford Ride, who has been a leading light all the way. We are extending the support that should be given to people in the community. The Gloucestershire county council has also responded to pressure and is pioneering major health education developments, but the burden is still falling on voluntary organisations, to whom I pay great tribute. Some housing associations have already been mentioned, and I refer to the Stonham housing association. I support the views that have been expressed. The Department of the Environment has bad ample opportunity to go to the forefront and say that housing is an important ingredient in the supportive assistance that is required by sufferers. I hope that we will have the chance to put a number of questions to the Secretary of State of that Department. Housing is essential to the care that must be provided in the community.
I am sorry to say that providing housing from scratch is likely to take two or three years under present bureaucratic procedures. I hope that something will be done and that housing associations specialising in caring for those in greatest need will be given the resources to enable them to move more quickly. The Stonham association has all the administrative know-how to do just that.
I want to mention one or two projects in which we should take an interest. As chairman of the Stonham housing association I say that we want to join all who are prepared to be realistic and who know about the awful harassment and inhuman treatment—and eviction—that is sometimes meted out to patients suffering from the virus. The National Association for the Care and Rehabilitation


of Offenders is another organisation with which I have been happy to be associated since its foundation. It will soon open a small unit for women; even before it has opened, a long waiting list has been drawn up. Both the organisations I have mentioned care and want to do something about the problems, and I associate myself with them wholeheartedly.
Local authorities have tried, but their resources are scarce. Many of their budgets have been pared to the bone. I put in a special plea to the Department of the Environment and to my hon. and learned Friend, hoping that he will be able to persuade that Department to invest more in housing projects.
A few words about the future. My hon. and learned Friend mentioned the importance of safe sex and of a programme to encourage people to recognise the dangers in which they place themselves. We must resist the persuasive siren calls of the well-meaning moral brigade, which maintains that we must pretend that extra-marital sex does not happen. More thought must be given to the free distribution of condoms. Clean needles are needed by people who have not weaned themselves off drugs, which were killers long before AIDS.
I have visited many of the facilities in London. It has been a moving and tragic experience to see them run under the splendid care of dedicated people such as Michael Adler, who has already been mentioned, John Galway and Charles Farthing, to name but a few who are struggling on with few resources. My hon. Friend the Member for Plymouth, Drake (Dame J. Fookes) and I returned from these visits completely drained. We set down the views that we formulated in a report that the Minister has not yet seen.
Many organisations deserve great praise for their preventive work and counselling. I shall refer briefly to two, the first of which is the London-based organisation Streetwise. Many hon. Members will have heard of it. I have visited it twice recently; it is anxious to provide a hostel of some sort for its clients. I do not know whether the House realises that, because of various socio-economic problems, youngsters come to London, imagining that the streets are paved with gold, from the age of 10 onwards. Young boys and girls of 11 and 12 are on the game. Streetwise picks up a large number of these youngsters and counsels them. Some want to come off the game, some do not. Streetwise has one tiny crowded room. At 6 o'clock, whether the organisation has been successful or not, all the children have to go out on the streets because there is no provision for short-stay housing. So a crash pad is vital —and it cannot wait for two years.
I also had the privilege of visiting Lighthouse. I strongly recommend anyone who has not done so to visit it. My hon. Friend the Member for Drake and I were immensely impressed by the work it is doing. It is bewildering to think, given the size of the problem, that Lighthouse offers the only modern hospice of its kind in Europe. I congratulate its staff, who are backed up by a large army of voluntary workers who want nothing more than to help their fellow creatures in distress.
I strongly emphasise the need for a crash pad, not only in London, but in all our major cities.
The Minister has displayed considerable tenacity in the face of opposition even from his own Back Benchers in his

efforts to enlighten the great British public. This is not an easy cause to espouse. Many of us who have espoused it in our communities have received unpleasant letters and telephone calls. To judge from some of them, I have neither father nor mother. Nevertheless, we believe firmly in what we are doing, and I pay tribute to my many colleagues on both sides of the House who work every week to provide what help they can and to stand up to this sort of vulgar abuse.
AIDS is Britain's most rampant killer. Over the years, measures have been taken to reduce the scourges of cancer, TB, dysentry, rubella, and, lately, salmonella. It is time we devoted resources and ministerial attention to ridding our shores of AIDS.
I do not denigrate the efforts that have already been made. I hope that it is not too wild to suggest to my hon. and learned Friend, with the greatest respect, that in the next Cabinet reshuffle a ministerial post might be created with sole and special responsibility for AIDS, given the massive threat that it will pose to the nation in the next decade. The costs of sensible preventive measures taken by the Government today cannot begin to compare with those of caring for terminally ill patients later.
We have not brought out the figures but they are astronomical. The cash implications will be dwarfed by the social devastation of the continued unchecked spread of the virus. We cannot rely all the time on the voluntary organisations who soldier on with great courage. Daily they are taking in sufferers from the streets of our cities, but now AIDS is beginning to rear its head in our towns and villages.
I recently visited Tanzania, and reference has been made to Africa, where in some areas entire villages have been wiped out. I hope that we do not see anything like that here. We must act now. The Government and the House owe it to the nation's children and grandchildren. If we do not act now, thousands of people will be wiped out through ignorance. That ignorance will be a terrible price to pay for lost future generations, especially if it were proved that we, as custodians of the nation's health, had failed to respond.

11 am

Mr. Gavin Strang: I am grateful for the opportunity to speak at an early stage of this debate, not least because of the importance of the subject to my constituents and to the city of Edinburgh.
I am happy to follow the hon. Member for Cheltenham (Mr. Irving) not just because of his interest in and deep knowledge of the subject, but because I strongly share his general attitude towards the people who suffer from AIDS. I believe that, when the British people understand fully the facts about the disease, a majority of them will agree with the hon. Gentleman's view.
The Minister has made a valuable contribution to the debate. A suggestion has been made in some quarters that, since the debate we had in November 1986, somehow the issue is not quite as serious as hon. Members—and certainly Ministers—had viewed it then. The Minister has refuted that. This is an enormous crisis in public health. As the Minister said, it is important to recognise that this is a new disease and, although we have learnt a lot about it, we have still a great deal to learn, not least about its transmission in normal heterosexual intercourse.


While only 1,059 have died of AIDS so far, as indicated in the Government's figures to the end of 1988, the reality is that many thousands are infected with HIV. The Government's figure is slightly higher than mine. They say that 80 per cent.—they have indicated that it may be higher—of the people infected with HIV will die of AIDS. In Germany a view has been expressed that it may be 100 per cent. if we wait long enough.
What must be understood is that what makes the disease difficult to combat is the delay between infection and development of the full AIDS syndrome. Although not much is known about it, it appears that minor symptoms sometimes occur after infection, but the average time between infection and the development of AIDS is between seven and eight years, but cases have developed between 18 months and 12 years after infection. Therefore, we cannot rule out the possibility that AIDS might develop a great deal later than 12 years after infection.
The report produced by the Lothian health board under the AIDS (Control) Act—I was grateful for the Government's support in introducing that Act prior to the last election—has given an excellent account of AIDS in Lothian. I would go so far as to say that, if hon. Members would like to read a good summary of the position with respect to HIV and AIDS throughout the United Kingdom, and Scotland especially, they could do a lot worse than reading that valuable report. I was glad to hear Dr. George Bath being interviewed on Radio 4 this morning on a programme which included comments from the Minister and my hon. Friend the Member for Peckham (Ms. Harman) because he rightly took the opportunity again to spell out just how important this issue is to the people of Edinburgh. As my hon. Friend the Member for Peckham reminded us, in Edinburgh—the incidence of the virus is higher in Edinburgh than in the outlying parts of Lothian—1 per cent. of young men between the ages of 15 and 44 are reckoned to be HIV positive, which is a startling figure. To put it another way, the area with the highest incidence of HIV after Lothian is the North-West Thames regional authority, but Edinburgh has more than twice the percentage rate of infection recorded in that regional authority.

Mr. Matthew Carrington: I do not want to enter into a competition on statistics, but it is worth bearing in mind that for the North-West Thames region, as for other regions in London, the concentration is very much on the health districts in the Inner London area. In the North-West Thames area the concentration is very much in my own health district, which is the Riverside area.

Mr. Strang: The hon. Gentleman will know that, under the AIDS Control Act, we have not only the report of the North-West Thames authority, but the reports of each district health authority, and that point is very well highlighted. One might well make a comparison between Edinburgh and the district health authorities rather than just the North-West Thames region.
I was grateful for the remarks of my hon. Friend the Member for Peckham. We need additional resources in Lothian. I accept that we shall never have enough resources, but we have a serious problem in the Edinburgh area and we want resources to tackle that. 1 was interested to hear the Minister speak about the Government's objectives for the area, which are common to both sides of

the House. He said that there was a need to build up services to prevent the spread, which of course is part of the solution. As my hon. Friend the Member for Peckham said, a lot of the resources are taken up in looking after the people who have developed AIDS. We have a tremendous opportunity in Edinburgh to slow down the rate of transmission of this virus throughout the community, especially between the injecting drug abusers and also into the wider community. I welcomed the Minister's statement about the needle exchange schemes.
Way back in September 1986 the McClelland report was published by the Scottish Home and Health Department. I shall quote one sentence from that report which was subsequently the view taken by the Government's Advisory Council on the Misuse of Drugs. We debated the ACMD report in my Adjournment debate last March. The report of the Scottish Home and Health Department said:
On balance the prevention of spread should take priority over any perceived risk of increased drug misuse.
Of course, we want to reduce drug abuse, but the priority must be to reduce the rate of spread of HIV infection.

Mr. Mellor: The hon. Gentleman is making a most attractive speech, which I am greatly enjoying. All of us are only too well aware of the particular problems in Scotland. As I understand it, my hon. Friend the Under-Secretary of State for Scotland announced in December a further £6·5 million for AIDS-related services. That will in effect mean that those services in Scotland will have £12 million funding this year as against £6 million last year. I am sure that that will include a basis for doing much more work in the areas he has mentioned.
I also know that I can say for my hon. Friend the Under-Secretary because it is what I say to colleagues in England, that when a legitimate basis for expenditure is found our task is to find the resources to meet it. I see the AIDS budget as one which will inevitably increase as the scale of the problem increases, and money is especially well spent in dealing with many of the areas that the hon. Gentleman has identified.

Mr. Strang: I am most grateful to the Minister.
We can use money effectively in the development of more needle exchange schemes. I believe that there is a strong case for establishing such a scheme within the prison in Edinburgh, although I accept that that is a controversial point. I was interested in what the hon. Member for Cheltenham said about the provision of condoms. We are aware that drugs are used in prisons and that, therefore, there is a risk of the HIV virus being spread in that way. I believe that we still have a great deal to do in Edinburgh to establish needle exchange schemes and to make them effective.
I was interested to read the remarks of the director of environmental health for Edinburgh district council, which is responsible for the housing authority and the environmental health authority, as opposed to the social services authority, which is run by the Lothian region. The director is not persuaded that the provision of needles through pharmacies is a substitute for the needle exchange scheme. The distribution of needles through pharmacies had been proposed by a Scottish Office Minister in an earlier debate, but I am not suggesting that there is any disagreement between him and the Minister of State, Department of Health.

Mr. Mellor: When I referred to funding I was talking about the service provision generally and what the hon. Gentleman said about the need for more to be done to deal with the spread of HIV infection. Obviously, I was not purporting to alter any of the bases of the specific issue of the needle exchange schemes. Obviously, that matter must be considered by Scottish Office Ministers and by other Ministers in the light of the evidence from the report that is now available. I am sorry to have interrupted the hon. Gentleman, but I wanted to make that point clear so that there is no misunderstanding.

Mr. Strang: I am grateful to the Minister.
I hope that when the Minister replies he will say something about the reports that have been published as a result of the AIDS Control Act 1987. In correspondence with me the Minister has said that the Government believe that it will be possible to improve the reports in future years. I was interested to read the report of the North East Thames regional health authority, which took the trouble to suggest how it thought the data in the reports could be better presented in the future. I commend that report to the Minister.
The authority suggested that the reports should be collated nationally, which was always the intention of the AIDS Control Act. We have had reports from the health boards and from the district and regional health authorities of England and Wales, and I had hoped that there would be a national compilation of them. This is only the first year in which the reports have been published and I accept that things will improve next year, but I hope that the Minister will accept that it would be beneficial if the reports were established on a more standardised basis so that there was a proper, national compilation of them.
When we discussed the AIDS Control Act we decided to place a requirement on health authorities not only to report the number of AIDS cases, but to give the best available information on the estimated number of HIV cases in their areas. The Minister's predecessor accepted the enormous importance of trying to get better information on the incidence of HIV in different parts of the country rather than working backwards from the number of AIDS cases in each area. That was the method used in the early days, but it was unsatisfactory. The Minister has accepted that the Government have recognised the need for the provision and publication of the best information obtained on the national incidence of HIV.
The main issue facing the Government at present on AIDS is prevalence screening or anonymous testing. I support the Government's acceptance in principle, of anonymous testing. We must consider prevalence screening because of the enormity of the disease. Everyone who gets AIDS dies and there is no dispute about the seriousness of it. There are other diseases, but prevalence screening is important, precisely because of the long delay between infection and the actual development of AIDS. On the grounds of measuring the Government's and the community's actions to control and reduce the rate of spread of the disease, and on the grounds of assessing how well we are dealing with it over the years to come, there is an overwhelming case for obtaining data on the incidence of HIV. We must address that issue.
It has been argued that none of the information obtained from prevalence screening will be useful, but I cannot accept that. The best examples of the use of such

information are the tests that have been carried out in New York. Every baby born in New York has the polimerase chain reaction test and in practice it is a test of the mother. The blood samples that are taken from the babies are tested for HIV and what is obtained is a good measure of the incidence of HIV infection among the mothers. There can be no doubt about the value of that information, which will increase over the years.
Of course, the information from anonymous screening is not random. If one is aware of the nature of the data and it is collected over a number of years, it is incontestable that the information obtained will be valuable to the Government and the nation in monitoring the spread of the virus. Therefore, we will know what is happening long before some of the positively tested people develop AIDS. As I have said, it can take as long as 12 years for an infected person to develop AIDS.
We must be careful about how we implement prevalence screening and it must be anonymous. People must not be allowed to opt out, however, because the value of the data would be enormously undermined if it were a voluntary test. If we are interested in receiving useful information, we must remove that element of subjectivity. We must have genuine, anonymous screening. We could, for example, take a blood sample from every women who is expecting a child or test every patient from a specific hospital for HIV.
It is crucial that such tests are anonymous and I support what the Minister said in reply to an earlier intervention. If people are to accept prevalence screening, we must ensure that there is no way that the medical staff or the technicians can find out, when a test is positive, the name of the person tested. If anonymity is not achieved, we shall not command the support of the wider community for the implementation of such a scheme.
Each blood sample must be labelled, but it is important to consider what information is put on the label. I believe that the person's sex and age should be on the label. The geographical area or the name of the hospital should also be on the label. Obviously there are complications about which the Medical Research Council must advise the Government regarding whether the label should say where the test was taken or where the tested person lives. There could be difficulties because of double testing and so on.
The fourth element that must be included on the label is the reason why a person had a blood sample taken—the reason why the person was in hospital. We need to know, for example, whether the person is a neo-natal mother or a casualty. There can be no doubt that we need those four elements, but that is all. Certainly there is no case for information on race or socio-economic group. If we put more information on the label, people will lose confidence in its being anonymous screening. I suspect that a substantial amount of scientific opinion would agree that those four elements will be sufficient to give us over a period of years valuable and important information on the incidence of HIV in the community and, thus, on the degree of spread, the rate of transmission and the success of the Government's policies in various geographical areas.
I support the Government's statements on anonymous testing. If I have a criticism it is that it has taken so long to reach this stage. The bullet should have been bitten earlier. I know that these are difficult issues and that many questions need to be addressed and I know that there are ethical considerations and that there is a need for complete


anonymity. But when the Medical Research Council gives its advice to the Government, I hope that Ministers will give priority to proceeding on this issue.
I support the view that this should be a non-party issue, and I appreciated the support of the Minister's predecessor and the Government in the enactment of the AIDS Control Act 1987. I hope that the hon. and learned Member who has taken over from the previous Minister, who has moved to higher things at the Department of Trade and Industry, will continue the valuable support which I received from his predecessor. At the end of the day, this issue will be non-partisan only if the Government address it with the urgency that the British people know it requires and allocate the resources which the community perceives as necessary to counteract the rate of spread of the infection and to meet the needs of the tragic cases who have become infected and are about to develop, or have developed, AIDS.
This is a major crisis. It is the biggest crisis in public health for over half a century. It is up to the Government, Parliament, and the community to meet the size of the challenge.

Mr. Chris Butler: I apologise in advance because I shall have to leave the debate early to battle through our congested motorway system to a constituency engagement in the north, but I shall read Hansard carefully when I return to the House next week.
I am disappointed that so few hon. Members are present for this important debate and I wonder whether this is a sympton of the denial that is often associated with this disease. The Chamber should be full. I hope that if these debates become an annual event, which I hope they will soon, the Chamber will be full in recognition of the importance of the issue to the whole nation.
The Prime Minister, with her usual prescience, said that by the year 2000 AIDS would be the major problem facing our country. The World Health Organisation estimates that by 1991, in two years' time, 2 per cent. of the world's population will be infected with AIDS. In sub-Saharan Africa the position is even worse, with 10 per cent. to 15 per cent. of many villages and townships already infected. That will devastate both the existence and economies of those nations and nothing can be done to stop it. The damage has already been done. No longer can we write off AIDS as something foreign and across the Channel, or as something confined conveniently to high-risk groups, such as homosexuals and drug takers.
We have already heard about the experience of Scotland. I understand that the disease is officially out of control among the heterosexual population there. Nowadays the major mode of transmission world-wide is heterosexual, not homosexual, activity. 1 believe that in one Paris hospital 85 per cent. of patients with AIDS show no sign of contact with high-risk groups.
The Cox report, which I welcome and which points to a certain under-reporting of AIDS cases, states that, bearing in mind that under-reporting, between 19,000 and 56,000 AIDS cases are expected in the United Kingdom within the next 10 to 15 years among people who are already infected.
The report of the Institute of Actuaries produced in 1988 looks further forward. It is interesting because the whole of the insurance industry depends for its survival on

its figures being correct, so I assume that its figures carry particular credibility. The report states that by 1994 there may be up to half a million HIV positives in the United Kingdom. That is in the high range of its estimates, but it depends on what I would suggest is an optimistic assumption that the disease will be confined to men and to homosexuals.

Mr. Chris Smith: That is not true.

Mr. Butler: That is true and afterwards I shall show the hon. Gentleman the report. The assumption is certainly not true.
So far the Government's approach to the disease has been sadly ad hoc and responsive, which is disastrous because the damage is done for seven to eight years ahead. We must be pro-active rather than reactive. I wonder where the sense is in closing some of our hospital capacity now rather than mothballing it, because if the institute's projections are right—I accept that AIDS patients will spend only 20 per cent. of their time in hospital—in the foreseeable future we may need an extra 100,000 hospital beds.
My hon. and learned Friend the Minister spoke at the World AIDS Day conference on 1 December, and I congratulate him because he went further than I have heard any other Minister go previously. I welcome the fact that he will update and publish regularly the Cox report and succeeding reports. He called for dispensing with the complacency that has characterised the debate on AIDS. He admitted that too often there was a process of denial in the approach to this disease. The history of plagues and epidemics through the centuries is of initial denial and of thinking that it cannot happen here, but it is happening.
The preconditions for success against this disease will be a belated recognition of the towering urgency and crisis that we are already facing. Information is as yet the only vaccine that we have. In the United Kingdom the public information campaign has increased awareness of the means of transmission of the disease, but sadly it does not seem to have affected behaviour among the heterosexual population. The Government's relative reticence so far has been reflected in many written answers that I have received.
The Minister mentioned that some years ago it was recognised the 30 per cent. of HIV positives would eventually develop the disease. I asked a written question on that when I was in possession of the facts of the Frankfurt and Redfield reports which show that up to 80 per cent. of HIV positives will develop the disease, but the Government gave me the figure of 30 per cent. That characterises the evasive attempts of his Department hitherto not to emphasise the threat and crisis of this disease. It is critical to our success in fighting the disease that we have the information for our "vaccine". That information is the AIDS status of the sexually active population. I believe that there is a case for mass testing. I know that people say that it might drive the disease undergound, but it is underground already. Up to 90 per cent. of those who are HIV positive do not know that they are and are infecting others unknowingly.
Another objection is that mass testing would impose a considerable cost on the Exchequer, but the cost would be small compared with the eventual cost of the disease. I believe that it costs about £30,000 per patient, and I also


believe that there will be a massive loss of productive power from the economy. I predict that one way or another mass testing will come about in this country, and we can approach it either reactively or pro-actively.
My hon. Friend the Member for Cheltenham (Mr. Irving) mentioned prisons. Prisons are a major source of crossover between the homosexual and heterosexual populations. They are breeding grounds for infection: levels of homosexual behaviour, tattooing and needle sharing are higher than those in the outside community. Prisons in the United States already bulge with HIV positives. I understand that in a New York federal prison between 30 and 40 per cent. of the inmates are HIV positive. The Spanish have tested all their prisoners and have found 18·7 per cent. HIV positive. About 120,000 people pass through our prisons every year, and even if the infection rate is half that in Spain it is clear that there could be an alarming outflow of potential infectivity into the population at large, threatening the wives and girl friends of prisoners who return to more normal behaviour patterns. By definition, prisoners have lost their civil liberties.
I believe that this is an overriding public health issue and that they should be compulsorily tested, although I accept that it should be done with full and appropriate counselling. Prisoners need the facts on which to base their behaviour, both inside and outside prison. It could be objected that prisoners' rights would be affected, but the population outside prison walls also has a right to protection against the disease.
I have heard from several quarters the call for condoms to be distributed in prisons, but I am very suspicious of such a move. The authorities would object that it condoned and perhaps even encouraged illegal acts inside prisons, but my objection is that it would be fruitless. Even the London International Group admits that no condoms are suitable for such use, and even among heterosexuals condoms fail all too regularly. I believe that the failure rate is between 12 and 15 per cent. Much of the propaganda telling people that they are safe if they use condoms misleads the public: it does not ensure safe sex.
Prisoners need a radical education programme on which to base their behaviour. Prison staff are very overstretched, and with the best will in the world I do not think that the job will be done properly if it is left to them. There may be an opportunity for voluntary bodies to become involved in educating prisoners.
Although I have not seen any reference to the defence implications of AIDS, I consider those implications increasingly important. The World Health Organisation has estimated that by 1991, two years hence, between 50 million and 100 million people will be infected worldwide.
Hon. Members should note the geographical distribution of the disease. In the middle east, eastern Europe and Asia its incidence is very low. So far, those areas contain only 1 per cent. of the total number of cases. If we are to believe the figures given by the USSR, it has only 90 seropositive citizens. My hon. Friend the Member for Lewes (Mr. Rathbone) may have latched on to a straw in the wind when he said that the USSR was now demanding testing for immigrants. Let us contrast that with the position in the United States, our major ally, where the

disease is officially out of control and 2 million to 4 million people are already infected, 500,000 of them in New York alone.
It should also be noted that the group among whom the infective pool will be concentrated are men of military age, between 18 and 50. The United States has already tested the majority of its army, and in September 1987 it found that over 1·2 per cent. of single men over 35 serving in the army were already HIV positive. The rate of increase in the United States is accelerating, not decelerating, and the doubling time of the disease fell last year to 13 months. At that rate it will not be long before an unacceptably high proportion of men of military age face premature disease and death.
I am not suggesting that AIDS is a commie plot. I subscribe to the cock-up rather than the conspiracy theory of history. Nevertheless, although it is a bleak scenario, there is the potential for military destabilisation. The eastern European countries can afford to sit back for some years, given their low rate of infection. If they then took the kind of measures that are so much easier in totalitarian countries—such as enforced mass testing, shifting of populations or internal exile—they might find it far easier than we would to control the impact of the disease.
I understand that the Soviet media have announced that 540,000 people in Leningrad have already been tested. No one can tell me that that was done on a voluntary basis. I suspect that it was enforced, and the betting is that the 540,000 were composed largely of men of military age, between 18 and 50.
We should also consider the air defence implications. The fourth international congress on AIDS in Stockholm presented a large number of papers. Abstract 8581 reported a deficiency in visuospatial processes among HIV-positive men, while abstract 8582 reported a deficiency in vigilance and verbal memory among HIV-positive men—as opposed to AIDS sufferers. Paper 8595 reported cognitive defects among United States air force HIV positives.
When someone is flying a combat aircraft, it takes only a small cognitive defect to create the potential for disaster. Flying such aircraft requires extreme precision and lightning reactions. Combat aircraft cost many millions of pounds; an AIDS test costs about 50p. In a written answer, the Minister of State for the Armed Forces told me that he was very much aware of those abstracts, but did not intend to screen air force pilots. I hope that it will not take a future disaster to make him dispense with his reticence. Before the gutter press descends on me, may I say that those remarks have nothing to do with recent sad events.
The matters that I have discussed are covered by three, if not four, Ministries: there could be five if the Scottish Office were included. That shows, I think, that the disease is spreading its tentacles through every aspect of our daily lives. It emphasises the need for a strategic approach to the issue.
Professor Adler has called for a national commission to deal with the urgency of the disease. He has expressed his desperation about the lack of co-ordination of Government Departments. My hon. Friend the Member for Cheltenham suggested that a case can be made out for an AIDS Ministry. If we do not act now, future—perhaps depleted—generations will criticise us. The whole history of plagues and epidemics suggests that extraordinary


measures need to be taken. AIDS is no exception. We have a window of opportunity in which to act, but it is closing and soon it may be shut.

Mr. Archy Kirkwood: I am privileged to be allowed to take part in the debate. I also had the privilege of taking part in the November 1986 debate.
The hon. Member for Warrington, South (Mr. Butler) made an interesting speech, and I agree with much of what he said. I agree that a national strategy is needed, but I became very nervous when he referred to testing. There are two ways in which to approach testing. One can oblige people to take tests or one can encourage them to take tests, as the Government have been doing. I prefer the latter course. I am not challenging the hon. Gentleman's good faith. We both wish to attain the same objective, but I counsel the Government to be cautious about taking up some of the hon. Gentleman's suggestions about testing.
The debate is timely. The fact that it is taking place now means that the Minister has had time to work himself into his new job. I underline what has already been said about the way in which he has responded to his responsibilities. I hope that he will continue to take the matter seriously. I hope also that the matter will not become a party political issue. There will always be differences of opinion about levels of expenditure, so I was nervous about the fact the the hon. Member for Peckham (Ms. Harman) strayed into the realms of party politics. The Minister will understand the spirit in which the comment is offered when I say that he does not have a reputation for not responding to provocation.
There is also a danger that the general public may become complacent. There is no complacency in hospital wards, research laboratories and hospices or in the counselling, advisory and voluntary organisations. I believe that there should be closer co-operation between the Government and the voluntary organisations. The hon. Member for Cheltenham (Mr. Irving) referred eloquently to the work being done by Lighthouse and other charities. It is difficult to overestimate the importance of the voluntary sector in the battle against controlling this disease. Hon. Members who take an interest in the voluntary organisations are filled with admiration not just for the work that they do and the way in which they do it but for the effectiveness of what they do. They are able—in a way that Ministers and Members of Parliament are never able to do—to warn those who are in the at-risk groups of the dangers and to suggest effective and acceptable preventive measures. They are talking on equal terms to the people whom they are seeking to help. No matter how well managed official bureaucracy may be, and no matter how well intentioned, the value of the counselling and advice given by the voluntary sector is much greater.
I give as one example of many the buddy system used by the Terrence Higgins Trust. It has provided nearly 250 buddies. It costs the trust £900 a year to finance them. They are on 24-hour call, they go out under any circumstances and they provide very effective help. There is no way in which to measure the value of the help that that organisation provides. We should recognise the quality, the quantity and the cost effectiveness of its work.
The Government must also pay attention to important matters relating to the voluntary sector. The problem is not unique to the voluntary sector, but I understand that it is very difficult for voluntary bodies to plan sensibly over a two or three-year period and to set up difficult projects unless they know how much Government money they can expect to receive. The Treasury rules create difficulties, but attention needs to be given to that problem.
I understand that the Department of Health expects voluntary organisations to make independent and separate applications to the different regional health authorities for central core funding for national activities. The £14 million that has been allocated to the regional health authorities is valuable assistance and will make a great contribution. Community-based initiatives are more effective because they are based in the community, but it is not sensible to expect organisations such as the Terrence Higgins Trust, Lighthouse, the Albany Trust and perhaps Streetwise to spend time, effort and resources on making individual applications to the regional health authorities for assistance. The national voluntary organisations should be allowed the privilege of making a once-and-for-all application. They should not have to run about the country trying to obtain core funding.
I was interested in what the Minister said about the Cox report. It is a valuable contribution to the debate. The recommendations are sensible and provide a basis on which to make plans. Does the Minister intend to use the Cox recommendations when planning financial increases? They are very substantial—38 per cent., 28 per cent. and 24 per cent. over the next three years. I know that the Minister has to fight his corner against the Treasury, but he said that he intends to use the Cox report as the basis for his Department's work. Does that extend to applying for additional finance?
There has been some difficulty over the advertising campaigns. I appreciate that it is not easy, particularly for a Conservative Government, to engage in some of these necessary advertising campaigns. Will the Minister consider involving the voluntary organisations in the planning of those campaigns? Their insight into the problem is special; they live alongside the problems that are experienced by the at-risk groups. It would be foolish not to allow them to take part in the valuable work that is already being done by the Health and Education Authority on a consortium basis. That would make it easier for the Government because if there were controversies they could say that it is not just down to the Health Education Authority—it involves the voluntary groups also.
When I visited the Terrence Higgins Trust 1 was slightly disappointed to discover that it could not run its valuable telephone helpline service for 24 hours a day. When I made my last visit to its premises, it had just finished a pilot project and had found that the telephone helpline could provide a valuable service in the hours when it is now shut down. At present it is operational for only certain parts of the day. A strong case can be made about that, because the Terrence Higgins Trust did the most valuable initial work to assist the homosexual group when it started to suffer problems from AIDS. I was interested to find that the trust now assists a wide range of groups. When I was there the trust advised some people who were inquiring about whether the AIDS infection could he spread through the


Church and its use of the common cup. The trust is making a valuable contribution through its helpline service to others as well as the homosexual interest group.
My next specific question for the Minister may be a little unfair so perhaps he will write to me about it. I am a little disturbed by the experience of the AIDS Health Education and Advice for the Deaf organisation. There seems to have been a bit of a bog-up somewhere in the bureaucracy. That organisation provides specific help on AIDS for those who are deaf. Its general secretary, Mr. Peter Jackson, was told just before Christmas that the core funding was being withdrawn. Will the Minister look at that matter and see what he can do to put it right?
I should like to spend the last few minutes of my speech dealing with Scotland because part of the focus of the debate has been the position north of the border. I pay tribute to the work done by the hon. Member for Edinburgh, East (Mr. Strang). His private Member's Bill was a valuable contribution. We now have the benefit of some of the reports made under that legislation. The hon. Gentleman has made a valuable contribution, but I would expect nothing else of him knowing how interested he is not just in his own constituency, but in the city of Edinburgh.
It is a stark fact that in 1983, when I was elected to this House, as far as we were aware no intravenous drug users in Edinburgh were infected. Now, 50 per cent. of intravenous drug users in the city of Edinburgh are infected. Those statistics frighten me to death. The hon. Member for Edinburgh, East referred to the remarks made on the radio this morning by Dr. George Bath that currently 1 per cent. of the 15 to 44 age group in that city is HIV-infected. That figure scares the pants off me. Some medical authorities have predicted that by the middle of the 1990s AIDS will be the biggest killer of young men in that age group in Edinburgh. We cannot ignore that.
The hon. Member for Edinburgh, East also referred to the McClelland report. I know that this matter is not directly in the Minister's brief and fully understand why we do not have a Scottish Office Minister present although I am sure that the report of the debate will be studied in the Scottish Home and Health Dept. The McClelland report was left unattended for too long.
I was interested to see the report by Mrs. Runciman, who chairs the Advisory Committee on the Misuse of Drugs. The report says:
We are deeply concerned that many of the McClelland report's recommendations have not been acted upon and we consider that vital time has been lost in tackling the spread of HIV in Scotland. We emphasise that many drug misusers are mobile"—
that point was emphasised by the hon. Member for Peckham, and I agree with it—
and that failure to curb the spread of HIV in Scotland will inevitably lead to the virus spreading more rapidly throughout the UK and beyond. HIV infection in Scottish drug misusers is not a problem for Scotland alone. it is a problem for the UK as a whole.
I agree that the response to the McClelland report has been too slow. To date, not enough of a lead has been given and until December there was a distinct lack of resources. Indeed, there is still a need for extra resources.
In our debate in November 1986 I called for condoms to be freely available in surgeries, clinics and at chemists. I intimated that I was deeply worried about the possibility

of the spread of AIDS through the intravenous route into the drug-using community in Glasgow. I note that the incidence of AIDS among intravenous drug users in Glasgow is only 34·7 per cent., compared to Edinburgh's 60 per cent. However, I believe that the figures for Glasgow are understated because when I ask the people working in this area there, they say that street conventional wisdom in Glasgow is, "Don't go anywhere near any survey. Don't get tested. Don't do anything. Stay out of the road of the official bureaucracy." That is one of the biggest problems with the intravenous drug transmission route. The lifestyle of some 80 or 90 per cent. of drug addicts does not take them anywhere near a Government Minister or a television set. Some of them cannot even read. If they can read they are often in such a state of intoxication that they cannot comprehend the message. There is a massive problem in trying to connect with those people. It would be difficult for anyone, but I wonder whether the problem is receiving enough consideration.
Returning to the role of the voluntary sector, I do not think that there is any alternative to trying to get folk who understand what is going on in the streets, under the bridges and in back closes in Glasgow to do the necessary work. In my view, that is the only way to make any real impact on the problem.
As for Edinburgh, two things strike me more than anything else. First it is unbelievable that Edinburgh does not have a proper drugs dependency unit. I do not understand why the Scottish Office does not attend to that as a matter of desperate urgency. It may well be a party political matter, but I make the recommendation as positively and urgently as I can. Secondly, Edinburgh must have a more effective needle and syringe exchange system in the near future. I do not consider that it is effective at the moment and the Scottish Office should attend to that.
The hon. Member for Cheltenham (Mr. Irving) has said everything there is to say about prisons. He has a proud record of arguing the case for action. I do not believe that we know what the dickens is going on in prisons. The spread of the virus in prisons is a unique situation. The spread of the risk depends upon the prevalence of the infection and that depends on the prevalence of activity. It is a desperate situation and again it is a gateway to the heterosexual population and that is very worrying. I believe that the voluntary organisations should be allowed to help. I understand that there are difficulties about that. At the moment voluntary organisations are technically banned from counselling and providing training in prisons. I know that the AIDS packs have been given to prison officers and I welcome that, but I do not understand how prison officers, in the context of the relationship between prisoners and prison officers, can easily make a connection that makes any sense whatsoever.
The Home Office should consider ways of introducing help through the voluntary sector. The Terrence Higgins Trust, the buddy system and the whole works should be turned on the prison system in an attempt to stem the infection.
In conclusion, I acknowledge that the issue presents unique problems for any Government because it is multi-disciplinary. As has been said, it involves various Government Departments and is, therefore, difficult to tackle. By its very nature, the campaign seeks to initiate changes in people's sexual and other personal behaviour and habits and that makes it a difficult problem for the


Government. It is uniquely difficult because it is a uniquely difficult medical condition to treat. I do not think that enough is being done. Every case that can be prevented will save future personal misery as well as future public expenditure. Nothing is more important than preventing the spread of the disease and we must apply more resources and engage in a more effective partnership with the voluntary sector to prevent the spread of such a dreadful disease getting further out of hand.

Mr. Tim Rathbone: My hon. Friend the Minister of State, Department of Health started this debate in a sensible and low key way, and I believe that the debate has lengthened its stride after each successive speech. That must be one of the most important elements of the debate. The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) drew attention to the dramatic threat of AIDS in this country and in the world as a whole.
The truth about AIDS is that anyone can become infected by HIV through blood contact or inheritance. I do not believe that inheritance has been mentioned in the debate so far. Everyone must be wary about that. Tests for HIV are very easy to carry out, but they test for infection only at the time of the test. If the virus is dormant in the body, it can become evident at any time. A negative test result does not guarantee absence of infection or give any idea of the risk of infection in future.
There is no cure for AIDS and no proven treatment for someone infected with HIV. There is considerable risk that a baby of an infected woman will become infected by AIDS. However, in spite of all that, attitudes to AIDS are extremely worrying and we should all welcome this debate on that score, because if nothing else happens—and I hope that much will happen—there should at least be greater awareness in the country about the threat of AIDS.
The fear about AIDS seems to be a mixture of a fear of the unknown, the incurable and the unlikely. There is also complacency in the belief that other people will catch it. They are usually identified as the immoral, those who behave promiscuously, black people—because of their supposed links with the spread of AIDS in Africa—homosexuals, drug misusers, and particularly homosexual drug misusers. It may be too easy for many people to blame those groups of people and their behaviour while avoiding questions about their own behaviour. Because of that, the infection has continued to spread among drug addicts in Scotland and in England and also among the heterosexual population.
I believe that there are still 14 Government-backed needle exchange schemes under which injecting drug misusers can bring in old needles and exchange them for new ones. I understand that by October last year 18,000 had used that service. However, too few of those people continue to use it. At the end of last year the statistics showed a 34 per cent. drop out rate after the initial visit and 53 per cent. after two visits. Perhaps the Minister has more up-to-date and better figures. Perhaps they are better than those I have quoted, but I have a feeling that if they are up-to-date they will show an even worse picture. I wonder whether health authority schemes based on the Government's scheme have been any more effective.
The hon. Member for Roxburgh and Berwickshire referred to the report of the Advisory Council on the

Misuse of Drugs which was extremely important. Ruth Runciman and her colleagues should be congratulated on the report. However, the Government's first reaction to it cannot be described as anything but bland. That was corrected somewhat in the more considered reactions towards the end of last year. I welcome the Government's confirmation of the report's categorical statement that prevention of drug misuse is now more important than ever. That cannot be stated too emphatically because of the horrors of drug misuse and the links between drug misuse and the spread of HIV. I pay due deference to the activities of the all-party drug misuse group, of which I am proud to be chairman. I pay tribute to the terrific work performed by my hon. Friend the Member for Bolton, West (Mr. Sackville) in the committee until he was elevated to grander and more powerful things. I do that because he is bidden to silence now.
I also want to congratulate the Government on what they are doing under the guidance of the interdepartmental ministerial group with regard to drug misuse and its connection with HIV. I particularly endorse the conclusion in its report, which was repeated by the Government, that effective and extensive education programmes are the most important influence on reducing the chances of people trying drugs and reducing the risk of the spread of AIDS.
The threat of AIDS overtakes even the miseries and threats of drug misuse. I am concerned that the Government have damned the advisory council's report with too faint praise and have shown too little willingness to embrace more wholeheartedly the report's recommendations to minimise HIV risk behaviour, despite the Government's more considered reactions that I mentioned earlier.
The day has now passed for the preparation of services "as necessary"—as the Government's reaction said—to reduce the risk of AIDS associated drug misuse. The report reads:
In all areas, substantial further expansion of drug misuse services will be necessary if services are to reach more drug misusers, and play an effective role in curbing the spread of HIV.
That means we should have more community-based services, more hospital-based services, more generic services and, above all, a better understanding of the problem among general practitioners. They should provide better services immediately and the Government must provide funding for that and for their education. This is a question of life and death for an increasing number of British people.
Some hon. Members have mentioned the special problems in Scotland and in prison. They require special and urgent attention and must not be pushed aside. The problems are serious in themselves and also pose a threat to the rest of the country as people move from Scotland and as prisoners return to life in the community at the end of their sentence. The problems of drug misuse show no signs of diminishing and deserve our continued positive. attention.
The question of funding must be raised in this context. I shall give three small illustrations of the way in which the shortage of funds can affect work at the grass roots. First, I spoke yesterday to the London Lighthouse, which is run by the Terrence Higgins Trust. It has 28 or 30 beds available but, unfortunately, it is using only 18. That is


because of a combination of the lack of pounds available to maintain the beds and the lack of trained nurses available to man the London Lighthouse.
Secondly, before coming to the debate I and my colleagues who share constituencies covered by the Eastbourne health authority attended a meeting with the regional chairman of the South East Thames health authority to inquire of him why his health authority has to carry out its work, including that involving drug misuse and the treatment of HIV, when it is funded to the extent of only 85 per cent. of the resource allocation working party's recommendation. That is the dramatic figure that a well-run, extremely efficient and thoughtful health authority has to work to because of a lack of Government funding for the region.
Even though the Government made £3 million available to regional health authorities last September to prevent the spread of AIDS among drug misusers and to help them make services better known and more widely available, it was not possible for the Government to help fund the East Sussex drug advisory council's trend monitoring unit—which is unique in Britain—largely because the 1983 drugs initiative fund had already been used up. The strategic approach mentioned by many other hon. Members is necessary.
There is a tradition of commitment to intersectoral co-operation within Brighton health district on drug misuse, AIDS and HIV infection. The co-operation between statutory and voluntary agencies has developed well. That is just as well because, in East Sussex, there is a significant drugs problem. East Sussex, tragically, has one of the highest notification rates per million of population in England, after London, Manchester and Liverpool. Many clients are poly-abusers of heroin, amphetamines, cannabis, minor tranquillisers, alcohol and cocaine, and for that reason, the drug advice and information service was set up in Brighton, funded by the Brighton health authority. It has been found that the awareness of the risks of HIV infection among drug users is extremely high. It was highest at the time of the Government's previous media campaign, but seems to have declined since, although such campaigns seem unlikely to change people's behaviour for any time. That was illustrated by the study on the illicit use of drugs in Portsmouth and Havant which was published last year. The drug advice and information service produced an excellent leaflet on AIDS and drug users which has been distributed among voluntary organisations and general practitioners, as well as through Department of Health channels. It is also of note that the drug dependency unit in Brighton has appointed a full-time member of staff to work specifically on preventing the spread of HIV infection among drug users.
East Sussex has also taken advantage of the educational support grant initiative to appoint a co-ordinator for drugs education in primary and secondary schools, further education establishments and youth services, although, as was said earlier, it is not so much the appointment that is important but the way in which it leads to more pupils acquiring a greater understanding of the issue.
I hope that I have given the House an insight into how one small area of the country, which faces a dramatic drugs problem, is dealing with the joint problem of drugs and AIDS.
I hope that what I have said will give greater encouragement to the Minister and the Government to take an even more imaginative strategic approach. Preventing drug misuse or achieving abstinence, where prevention has failed, remains the primary goal. However, HIV infection has given far more importance to the intermediate goals of attracting drug users into services and helping them to change their high risk behaviour. That is the crux of the matter, as the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) said in the Scottish context. If we do that successfully, we shall prevent the rapid spread of HIV among drug users and, ultimately, among non-drug users, but additional resources for the expansion of services must be provided. The only choice is whether to spend money now on curbing the spread of infection, not only through health care but through education, social services, housing and voluntary organisations, to which the hon. Member for Roxburgh and Berwickshire and my hon. Friend the Member for Cheltenham (Mr. Irving) drew particular attention, or to spend vastly more in a few years' time on the care of people with AIDS.
I welcome profusely what the Government are doing but humbly and hopefully ask the Government to do more. If the Minister pursues the problem of AIDS with the vigour with which he pursued the problem of drugs when he was a Minister of State at the Home Office, I and other hon. Members will not plead in vain.

Mr. Chris Smith: I thank the Government for making this debate possible. I give them considerable credit for much of what they have done in response to the problem of AIDS. The British Government have been considerably ahead of many other Governments in this respect. That does not mean, however, that they are perfect, and I hope to draw attention to some areas in which improvements can be made. A good start has been made and the Government deserve credit for that.
I cannot stress too strongly how important a fair, sensitive and sympathetic understanding of AIDS and HIV infection is. Too often, the advent of this tragically life-threatening disease has been used as an excuse in the tabloid press and by some irresponsible commentators for prejudice, intolerance and abuse. Many of those who face the onslaught of the disease or the virus which gives rise to it find that they are fighting not just their potential illness but discrimination and harassment. They need care and help but often find themselves at the receiving end of blame.
We need a cure for two diseases—for HIV and for the bigotry to which it sometimes gives rise. A number of my constituents—some of my friends—are touched by the disease. Many are living with extraordinary courage with the day-to-day facts of AIDS. Some face opportunistic infections and illnesses which are painful in the extreme. All are living, struggling human beings, citizens who deserve the understanding, sympathy and help of the House and the Government.
What should the policy response to AIDS be? I shall outline four categories of concern—first, public health education; secondly, health care and social support for


those who are affected; thirdly, medical research to combat the virus; and, fourthly, tackling the discrimination to which AIDS has given rise.
The Government deserve the greatest praise in regard to public health education. They rightly identified very early on that it is the principal weapon in our armoury against the spread of HIV. I have some criticism to make of some of the advertising material, especially that in the early days, which seemed to generate more fear than enlightenment, but there has been a considerable improvement. I might question the recent decision of the Health Education Authority not to use television advertising or hoardings in its latest campaigns. Restricting advertising activity principally to newspapers does not, I suspect, reach the major audiences who need to be reached. I hope that the HEA will review that decision in the not-too-distant future.
The greatest possible credit must be given to people who work in hospitals which are most affected by the AIDS epidemic. They provide the highest possible quality health care to people affected by the disease.
The Government have set aside funds for the AIDS problem. I was pleased to hear the Chancellor of the Exchequer announce in his Autumn Statement the increased funding that he is allocating for AIDS in the coming financial year. However, two questions remain, and I hope that the Government will begin to address them. First, for example, is the only currently prescribable drug that has been shown to have particular effect against the HIV virus, AZT—nowadays known as zidovudine—available to everyone who can benefit from it? I suspect that, currently, the answer is yes. However, if studies that are currently being undertaken in the United States reveal within the near future that AZT can be especially effective when given to those who have not yet developed AIDS symptoms but are HIV positive and that early use of AZT can be considerably more effective than late use, I hope that the Government will ensure that AZT is available for use by patients who require it.
At the same time, perhaps the Government could take up with Burroughs Wellcome the cost of AZT. Pharmaceutical companies' pricing policy for drugs that can he used to tackle the HIV virus is extremely important. As drugs become more widely used and more effective, pricing and cost to the National Health Service will be extremely important.
Another health care question is whether prophylaxis against certain opportunistic infections, and especially against pneumocystis, which is the most deadly of the opportunistic infections that can affect AIDS sufferers, is available.
It is difficult to overestimate the importance of medical research. Successful research carried out now can save hundreds of millions of pounds in long-term patient care. Sadly, a cure for AIDS will amost certainly be a long time coming. In the meantime, all indications are that, within a relatively short period, it will be possible to produce anti-viral therapies and drugs that can at least slow down or, in some cases, halt the progress of the virus in an infected person. The development of such drugs is crucial. The use of drugs for early intervention, at the first moment that infection is known, to try to slow the latency period between infection with the HIV virus and the development of the constellation of infections that are known as AIDS is extremely important. I hope that the Government will direct more of their research effort to early intervention.
I have some questions about the wisdom of the decision by the Medical Research Council to devote so much of its directed programme effort to the search for a vaccine. I suspect that a vaccine will be a long time coming, and will be found only after we have some more successful drug therapies to counter the activity of the virus. The priority should be to tackle early intervention rather than to develop a vaccine. That does not mean that we should drop all efforts in search of the vaccine, but perhaps the priority of the MRC-directed programme has been wrongly focussed in that respect.
The other issue connected with research and the use of early intervention drugs is the availability of successful therapies for patients who need them. Much work is being done on a number of possibly hopeful products in the United States. Two of the especially hopeful ones are drugs known as DDI and soluble CD4. There is some sign that such drugs can be more effective than AZT. They are already under preliminary patient trials in the United States. Those trials must be done; we must know more about the side effects and be careful about how such drugs are tested and produced. But if they are clearly shown to be effective, it is important that they be rapidly and readily made available for people infected with HIV in Britain. l hope that the Government will ensure that the time between the identification of a useful product and its provision for patients who need it is as short as possible.
Discrimination is the fourth subject that must be dealt with. The insurance industry practises a certain amount of it. Admittedly the industry has a major problem with people who are already HIV positive. We must accept that. An assessment of the risk of mortality will clearly be affected if people are in this position; it is beginning to cause considerable difficulties with access to housing and mortgage finance. That aspect needs careful consideration in the context of housing policy over the next few months.
However, we must take issue with the insurance industry on a number of points. First, the predictions that the industry makes about the spread of the HIV infection go wildly beyond those made by Professor Cox. We must ask the actuaries precisely where they get their information and ideas about future spread from. It is on that information that they base much of their premium accounting, and I do not think they have got it right.
We must also tackle the insurance industry about its treatment of the groups in society who have become known as high risks. The message that we need to give the industry is that, with HIV, it is not membership of a high-risk group that matters as much as high-risk behaviour. The difficulties that young single men experience in obtaining life insurance stem from a misconception on the part of the insurance companies about the nature of the virus and the ways in which it is spread. The questions that are frequently asked on insurance application forms about whether applicants have sought counselling for AIDS or have been tested for it, and the deductions made by the insurance companies based on their answers, are particularly dangerous. They act as a deterrent for those who should be going to get tested. This will become especially important if, in the near future, it becomes obvious that a product such as AZT can be especially effective in the early stages of infection. It will then be especially important for people to come forward and identify themselves for testing at the earliest possible opportunity. If insurance companies' deterrent actions make it difficult for an applicant to receive insurance cover


if he answers yes to the question whether he has been tested, it will be difficult to persuade people to come forward for testing. That is a basic and simple point and I hope that insurance companies will begin to take it on board.
The secondary area of discrimination which is of great concern is employment. We know of a number of cases where an employee has been dismissed because he is HIV positive. Although some progress has been made in industrial tribunals on the question of unfair dismissal, the problem remains. A number of people have been dismissed, ostensibly for other reasons but in reality because they have been found to be HIV positive. There should be no excuse for an employer to take such action, where the medical circumstances of the person concerned are simply that he is positive, and is still perfectly able to carry on his work without any danger to his fellow employees or to the general public.
In some ways even worse than the relatively small number of cases of dismissal are the requirements that are now being made by a number of firms and organisations for applicants for jobs to take HIV tests before they can be considered for employment. I fear that a number of firms are especially bad in that respect. Texaco is the most obvious. It requires potential employees to take HIV tests, despite the fact that there is no medical reason why an employee of Texaco, who registers as HIV positive, may not be able to provide years of extremely valuable and useful work to that employer. British Airways, too, requires a similar test on its employees. The same used to apply to Dan-Air, which some years ago decided to employ only female cabin staff on its aircraft. I am pleased to say that Dan-Air was taken to the Equal Opportunities Commission because of that decision and, after a thorough and extensive investigation, a finding was made against it. Dan-Air advanced as its reason for taking that decision its concern about HIV infection among men. The Equal Opportunities Commission made its finding and Dan-Air, I am pleased to say, abandoned its policy.
I hope that other employers who are undertaking similar activities will rethink their employment practice. One of the most worrying examples of such employers is the Metropolitan police. A potential recruit to the Metropolitan police must fill in a questionnaire which contains the question that appears on insurance forms about whether one has ever been tested or counselled in relations to HIV or AIDS. That is not good enough. I am afraid that the answers that I have received so far from the Home Secretary to my questions about that practice have been unsatisfactory.
Many states in the United States have implemented anti-discrimination legislation which makes it unlawful for an employer to discriminate against someone because of his HIV status. It would be useful if we could ensure that such legislation was put on to our statute book. I hope that the Government may give some consideration to that in the coming parliamentary Session.
We need to co-ordinate our activity over a wide range of concerns affected by the threat posed by AIDS and HIV. We must consider public education, the care and the social support available to those who are infected and the crucial question of the research that has been done and

how it has been put into practical effect. We need to ensure that discrimination does not take place arising out of the tragedy of AIDS.
The Government have made a good start on many of those aspects of the problem, but there is much more that must be done, and I hope that the Government will take further steps in many of the areas that I have outlined, because, hundreds of thousands of lives depend on it.

Mr. Roger Sims: The hon. Member for Islington, South and Finsbury (Mr. Smith) made an interesting and well-informed speech. I hope to make an equally worthwhile contribution to the debate and, perhaps, to touch upon some of the points that he raised.
Society falls into four categories in the context of today's debate. First, there are those who, alas, are suffering from AIDS or the HIV virus. Secondly, there are the doctors, nurses and all those engaged in the care and treatment of and research into AIDS. They are familiar with AIDS. Thirdly, there is a number of people, such as Members of this House, medical journalists and a relatively small proportion of the community who are not professionally qualified, who have sought to inform themselves as much as possible about the nature of this dreadful disease.
Fourthly, there is the vast majority of the population, our constituents, who, I am afraid, despite the best efforts of the Government and the health education agencies, have only the sketchiest knowledge of what it is all about. They do not profess to understand AIDS fully, nor do they appreciate its extent. In fact, they do not realise the implications of it. If today's debate will do something to dispel a little of that ignorance, it will be time well spent. There is a real danger, as my hon. and learned Friend the Minister has already said, that AIDS will just come to be accepted as part of everyday life.
If public knowledge about this matter is sketchy, it is also fair to say that about us. We know how many people have AIDS and how many people have died from it. We know that, at the end of last year, there were 1,982 cases of AIDS, half of whom had died of the disease. There are about 9,603 known cases of HIV, but that does not mean that that represents the total figure. We do not know how many people are HIV positive, but the estimate is about 50,000. The comparable figure in the United States is between 1 million and 1·5 million people. It is also estimated that, in this country and the United States, up to 90 per cent. of those people will, during the course of the next decade, develop fully blown AIDS.
We must grasp the implications of this new phenomenon. For a start, new and extremely expensive forms of care are required. The Government have allocated a further £130 million over the course of the next three years to cover the cost of extra nursing care, but will that be enough? It is a substantial figure, but, frankly, we do not know whether it will be adequate. All care will not be in hospital. In this morning's debate several hon. Members have referred to the need for community care and how important it is. It is relevant to know what the Government's reaction will be to the Griffiths report. Perhaps all one can say on that is, how long, oh Lord, how long? We are to have a review of the National Health Service, and I hope that at the same time we shall have a response to Griffiths and be shown how we shall proceed.


We know that hospices and the hospice care movement, which has become increasingly important for caring for what might be described as the conventionally dying, will almost certainly need to expand substantially to cope with AIDS victims. The Government have allocated £7 million for local institutions and voluntary bodies which, as several hon. Members have said, are so important in this context. Will that be anything like enough for the role that will face the hospice care movement?
We have heard figures of the likely number of AIDS patients and there are varying estimates of the cost of hospital treatment. Hospital treatment alone probably costs about £25,000 per patient, excluding all the ancillary expenses. It is not difficult to begin to estimate what the cost of AIDS will be to the country simply in terms of £sd. The costs could be astronomical and could seriously affect the whole development of the NHS, the plans for which we look forward to hearing shortly.
Furthermore, at a time when the proportion of people in their late teens and early twenties is diminishing, an increasing number of them will be unavailable for the work force because they will be dying of AIDS. My hon. Friend the Member for Warrington, South (Mr. Butler) spoke of the implications of that for the armed forces. Let us remember that, while the NHS and the independent sector of medicine will be faced with a diminishing pool from which to draw nursing recruits, an increasing number of those nurses will have to devote their skills to caring for AIDS patients at the expense of their other duties.
There are at least three steps that the Government must take. First, they must undertake research into treatment and cure, and that is exactly what they are doing to the tune of some £31 million. The Medical Research Council is directing a comprehensive programme, and I am not sure that I agree that it is for us to be telling it in which direction its research should go. It is satisfactory that research is going on and that sums are available for it. Recently I was talking to a researcher in this area who told me of a conference that he had attended, at the end of which a representative of the MRC asked any researcher who had a project on AIDS to tell the council what it was and the council would fund it. That paints a rather different picture of medical and other research from what we are often led to believe.
Secondly, the Government must encourage local initiatives for the care and treatment of AIDS patients. We have heard how sparse they are, and obviously they will be needed increasingly. Some voluntary organisations are particularly well equipped and experienced to provide that care.
Thirdly, the Government need to mount campaigns of education and information aimed particularly at preventing people from getting AIDS and, again, the Government are doing just that. But it is proving extremely difficult and it is a sensitive and complex area for advertisements and promotions. I am sure that initially the Government wished to aim at the whole population to try to explain the problem. In doing so they perhaps shocked people because they had to use, on radio and television and in the press, language which had not previously been used in polite circles—I put it no higher than that—and it upset many. But I am sure that it was right to do that to ensure that people were aware of the problem.
Now, rightly, campaigns are being aimed at the most vulnerable groups by way of posters, newspaper advertisements, leaflets, television and so on. The trouble

is that, as my hon. Friend the Member for Cheltenham (Mr. Irving) has said, we need only tell people that eggs are likely to give them salmonella for everyone to understand. Everyone has had stomach trouble after eating food of one sort or another, and that is the kind of issue that the media are happy to grasp the opportunity to publicise. But how can we explain in simple terms what is meant by HIV, ARC and AIDS, when the symptoms are not specific and such symptoms as are present may be symptoms of something quite different? People may be suffering from HIV with no symptoms whatever. How can we get the facts across to young, fit men and women who are enjoying life and, inevitably, experimenting?
The "Don't inject AIDS" campaign was a good one which seems to have got across, and the current poster aimed at drug users which we see in the Underground is very effective. I am not so sure about the double-page newspaper advertisement showing someone suffering from AIDS and suggesting that 30 others probably have the virus. I do not know whether either the presentation or the wording will be understood by those at whom the advertisement is aimed, if indeed they read it. It is not particularly eye-catching. It could also be misunderstood: it could be interpreted as meaning that one person in 30 with HIV may develop AIDS. But, as my hon. and learned Friend the Minister said, there are estimates of 80 per cent. and more. Perhaps the advertisement is not ideal.
I am not necessarily criticising the Health Education Authority, or advertising agencies if they are responsible. It was a worthwhile effort. I use that example simply to illustrate the problem of putting over the facts and figures about this complex matter. The dilemma is in deciding the style and content of the message that we are trying to put. across. If we try to tell people what they should and should not do, we are likely to be criticised for preaching and moralising. If, on the other hand, we speak in vague terms., we shall be criticised for not being specific.
My hon. Friend the Member for Derbyshire, South (Mrs. Currie), the former Under-Secretary of State for Health who recently left office, was criticised occasionally for saying things like, "Don't sleep around", but that is the sort of direct language that is necessary. As with so many things that my hon. Friend said, at least it got people talking and thinking. Perhaps Ministers should not preach, if by that we mean referring to personal conduct based on religious principles; people, after all, have differing religious principles. One might hope, however, that some of the religious leaders will occasionally do a bit of preaching about this, and particularly that the Church of England will take a lead from the Chief Rabbi.
Is it so wrong to moralise? Surely to moralise is to lay down what is right and what is wrong. In many spheres that is a matter of personal judgment: what is right for one person may be wrong for another, not least in matters of sexual activity. Surely, however, it must be wrong to indulge in practices that not only put the person indulging in them at risk, with all the accompanying costs to the community, but put others at risk of a long and distressing illness and premature death. Part of our education programme ought to involve moralising in that sense.
In her admirable analysis entitled "The 20th Century Plague", Dr. Caroline Collier suggested that we should bring back into prominence two old-fashioned words—chastity and fidelity. The Health Education Authority might care to consider using those watchwords in future campaigns. This problem can be controlled not by


Government but by the behaviour of individuals. When a problem of this kind arises, people tend to say, "They ought to do something about it. What are they doing?"—"they" being the Government. The Government are doing a great deal. I hope that this debate will provide further publicity for what they are doing.
At the end of the day, whether AIDS will be controlled or contained or whether it will become the worst epidemic that mankind has ever seen will depend not on Government or Parliament but on the extent to which individuals, especially those who are sexually active or who are in the habit of taking drugs, are prepared to adapt their lifestyle.

Mr. Tom Cox: I, too, welcome this debate and I congratulate the Government on initiating it. It has been a constructive debate on one of the major issues facing this country. I intend to concentrate solely on those with AIDS who are sent to prison and on the kind of care that is given to them while they are inside.
The report of the Select Committee on Social Services "Problems associated with AIDS', illustrates how little is being done for those with AIDS who are serving prison sentences. Recommendation 40 says:
We reiterate our conviction that prisoners who are seriously ill should normally be in hospital, not in prison".
Hon. Members who have any experience of prisons will fully agree with that recommendation. Recommendation 41 says:
If the Departments responsible for the prisons of this country have grasped the full implications that AIDS and HIV will have for the prison system, they have yet to show it.
Those are the Committee's comments, not mine.
We do not know how many prisoners are suffering from AIDS. How can the prison authorities find out? Some sufferers may say when they go into prison that they have AIDS, but others fear to do so. In some European countries, all prisoners are tested for AIDS on reception. Although it may not be a popular suggestion, we need to consider the introduction of a similar procedure. If we knew how many prisoners were suffering from AIDS, a prison department policy on reception and treatment would have to be introduced. Many prison inmates who suffer from AIDS are treated like the lepers of old. No one wants to know. They are put out of the way and out of sight. Although the rights of prisoners in general may be limited, if a prisoner has AIDS his rights are virtually non-existent. A prisoner suffering from AIDS is not always put into a prison hospital, and in any case the conditions of many prison hospitals are an utter disgrace in this day and age.
However, having seen a prison in my constituency, I pay the warmest tribute to the way in which prison staff, who work under often the most appalling and inadequate conditions, deal with the normal complaints that they have to treat. However, the treatment that a person suffering from AIDS can look for in prison is virtually non-existent. I understand that only Brixton prison has some provision for AIDS sufferers. By "provision", I mean that Brixton prison hospital has two or possibly three beds where some kind of treatment can be given to a prisoner suffering from AIDS. The sad thing is that the authorities do not seem to have any idea of the numbers.
The vast majority of prisoners suffering from AIDS are put into single cells, away from other inmates who may not wish to have anything to do with them. They have little or no association. They exercise and eat on their own and must use only their own utensils, because, as I shall show, the prison authorities have not yet started to understand them or to give the sympathetic consideration that should be given to anyone who is suffering from AIDS and is in prison. Although I am sure that there are some sympathetic prison hospital staff who would willingly try and who would like to give care to the people in their charge, that is not true of all prison staff. I am told that some prisons refuse to accept any inmate who is thought to have AIDS. I suppose that that is because of the fear of what AIDS may do to the people who are fortunate not to have the illness.
Paragraph 92 of the report of the Select Committee on Social Services leads one to ask what is happening. However, I must pay tribute to the Minister of State. Department of Health, as have other hon. Members, for the progressive thought that he and many of his colleagues in his Department have given to this matter. I know that he was once a Home Office Minister. Paragraph 92 states:
in our Report on the Prison Medical Service … we discussed briefly the problem of AIDS in prison. Lord Glenarthur assured us last year, on behalf of the Home Office that there was 'absolutely no complacency' about AIDS … It is therefore surprising to learn that the Home Office has decided to issue protective clothing to all prison establishments for the use of officers dealing with patients suffering from AIDS. Such a reaction appears to reflect apparent ignorance of the method of transmission of the AIDS virus and of the risks to officers when dealing with such inmates.
I accept that the Minister is a sympathetic person. He and I have often dealt with issues of mutual concern. Therefore, I beg him to find out after the debate—I realise that he cannot do so during it—whether that philosophy is still operating in the Home Office. I am sure that hon. Members on both sides of the House will agree that if that is its thinking, heaven help people suffering from AIDS who are sent to prison.
We have heard a great deal about the funding that is available throughout the country. What funding is available within the prison department? What funding is available for the current year, which one assumes will end in March? What funding is proposed for next year? I understand that there is a moratorium on all prison expenditure for the current financial year. If that is true, it appears that whatever money may have been spent, no additional money will be spend on helping people and prison officers working in our prisons and on people who have AIDS and are in prison.
I share the view that has been expressed in reports that inmates with AIDS should not be in prison but should be in outside hospitals. However, I understand that that would create problems. If someone is serving a long sentence it is difficult to find a hospital that will accept such a responsibility. Therefore, it is the responsibility of the Home Office to ensure that there are modern prison hospitals with all the modern facilities that are needed to treat the disease, where patients can be kept and not treated in the way that I have seen them treated in prison. I am not quoting from reports now. I have actually seen inmates being segregated, with all the problems that that creates.
Finally, if we examine this increasing problem, as other responsible bodies including the DHSS have, it becomes


clear that there really is hope. As other hon. Members who have not made such extensive comments about the problems in prison have said, not only will action benefit inmates who have AIDS while in prison, but it will greatly benefit them and their families and friends when they eventually come out of prison and start life in the outside world.

Mr. Matthew Carrington: This has been a serious but depressing debate. Perhaps the least depressing part of it was the comment of my hon. and learned Friend the Minister of State that if any projects are produced for assisting with solving the problem of AIDS, it is his job to find the resources to enable them to go ahead.
The problem of AIDS is made very depressing by what is apparent from the debate and from all the literature: there is no great understanding of the disease. There is no explanation of the difference between the transmission of the disease in Africa and in America and the significant differences between what is happening in Britain and what is happening in the United States and the rest of Europe.
My constituency is in the Riverside district of the North West Thames regional health authority. The Riverside district has some of the highest incidences of people with AIDS and people who are HIV positive. My constituency contains a large number of such people, probably because St. Stephen's hospital, which is about a quarter of a mile outside my constituency, has the Kobler unit for the treatment of AIDS patients. That is partly a reflection of the number of people in inner London who are in the groups which are vulnerable to becoming HIV positive, but it is also a reflection of the fact that people who have, or suspect that they may have, contracted HIV to come to London either to get treatment or to escape from their backgrounds or from a society which may be less tolerant of people with that disease than those in London. As a consequence, inner London areas are forced to accept the enormous responsibility of looking after people who suffer from HIV and AIDS. The social services, the Health Service and council housing departments have so far tackled that task to the best of their abilities with the support of the Government who have provided considerable financial resources.
The problems facing AIDS patients have been well rehearsed in the debate. An HIV patient suffers from isolation within the community, discrimination in housing—and probably in employment—and socially at the hands of erstwhile friends, colleagues, acquaintances and neighbours. HIV sufferers also have personal problems of isolation, uncertainty and fear about the future. There was a time when it was thought that someone who was HIV positive would not necessarily develop AIDS. Although the suggestion is that there is an 80 per cent. probability that HIV sufferers will develop full-blown AIDS, the reality is that illnesses among HIV positive patients are significant even before they develop full-blown AIDS and become recognised as AIDS statistics.
HIV sufferers place excessive demands on the social services, the Health Service and the voluntary services. That demand also falls on the rest of the community. We must all be able to understand and support them. We must also be able to help people who come into contact with

HIV sufferers to understand the problems facing sufferers and the threat that they do or do not pose to people who come into contact with them.
The Government's advertising has concentrated quite rightly on the groups in the community who are at high risk of AIDS such as drug users and the gay community. However, the message has not been conveyed that AIDS is not just a disease of the gay community or drug users. It is a disease of the heterosexual community as well. It is only a matter of time before significant numbers of people acquire AIDS not by misusing drugs, or being part of the community which other parts of the community despise wrongly, perhaps, or through blood transfusions, but have simply acquired it by leading a normal life. That message must be put over.
One of the sad consequences of AIDS that I have witnessed in inner London is the upsurge in prejudice and physical reaction against the homosexual community. That is very worrying, but is perhaps always latent in the heterosexual community. However, that prejudice has been given a reason to come back into the open again in a very distressing way in inner London.
Ignorance about AIDS is not confined to the uneducated or ill-informed. I am afraid that from the stories that I have heard from the medical school in Charing Cross hospital, problems of ignorance arise among people in the medical profession. The amount of education needed and the necessity for change in attitudes is much more urgent than was first thought.
I am more concerned about the future services to be provided for people who are HIV positive than about those provided today. No one can predict how many patients there will be in the next 10, 15 or 50 years. It is impossible to foresee the course of the disease, the percentage of infection that will occur and whether ways of controlling the spread of infection or of curing people with certain strains of the infection will be found. I suspect that, on the present evidence, it may be optimistic to speculate that we will be able to cure all strains of AIDS and HIV infection, but over time we may be able to control them.
The number of infected people making demands on the inner London health services and the voluntary services is rising exponentially and rapidly to a point where, if action is not taken now to provide care within the community, it will be too late. We shall be forced to take rushed action when the problem causes severe social tensions within the community.
People who are HIV positive experience different problems from those with full-blown AIDS. They need to be able to live a normal life in the community. People with AIDS are likely to need much more nursing care and more attention from health professionals. People who are HIV positive face housing problems which must be met. That can be done partly through hostels and sheltered housing that will allow them to live within the community but be protected and provided with necessary counselling. Those problems must be addressed now. That is difficult when we cannot predict how many people will need the resources and what types of resources they will need. However, the evidence is such that we should be making much greater provision than is apparently being made, certainly in inner London.
Anonymous testing was mentioned earlier. I understand the civil liberties arguments and I substantially agree with them. I understand that the need for research-based


understanding of the spread of the disease is overwhelming. However, I am concerned that if the testing is left on a purely voluntary basis, people who are HIV positive and who do not understand the risks of their condition may unwittingly infect other people.
AIDS is much more serious and presents a more serious prevention problem than many other diseases. A line can be drawn more effectively than it has been so far between the anonymity of testing and being able to help people who are unaware of their problem but who will need support and counselling. Such people could be tested when they attend for a blood test or visit a hospital for other medical reasons.
Even more serious than the domestic problems of AIDS is its international consequences particularly as it affects the less developed countries, notably in Africa.
The official statistics coming out of Africa significantly understate what seems to be the reality from and anecdotal evidence of people working in the communities of east and central Africa. It is likely that the communities there are suffering badly from an endemic version of AIDS which has spread through the hetrosexual community by normal sexual activity. It is not subject to the expectations that were originally formed about the way in which AIDS would be transmitted and it is, therefore, not subject to the normal preventitive measures that can be taken to stop its transmission.
I have heard it said—I suspect that there may be an element of exaggeration—that officers of the World Health Organisation are deeply pessimistic about the future of central Africa. They believe, because of the way in which AIDS has become so well established in those communities, that unless a natural response is developed within the human body to the AIDS virus, AIDS is likely to create such devastation that those countries will find it difficult to exist much beyond the next 20 or 30 years. The problem is worldwide; it is not a problem that Africa can face or address by itself. It is not merely a research problem but a sociological problem of the African villages and way of life.
The spread of AIDS is a problem in which we, through the Commonwealth, are almost uniquely able to assist. I know that a great deal has been done through various development agencies and the World Health Organisation, but part of the difficulty that is faced, especially through the WHO, is the reluctance of Governments in those countries seriously to address the problem and to acknowledge its extent. Our Government should be examining carefully ways in which to persuade those Governments to accept the assistance that we, Europe and the United States should be able to give them so that they can provide the sociological support necessary to overcome the problem. That effort should be increased even more, although I realise that the Government do a great deal at the moment and intend to continue to do so.
The research problems connected with AIDS are part and parcel of the effort required and research needs to be supported on a worldwide basis. Although this country's research effort is paramount, our co-operation with research in the United States and the WHO must be such that it will lead to the development of the cure for AIDS which we all desire.

Several Hon. Members: rose—

Mr. Deputy Speaker (Mr. Harold Walker): Order. I can see five hon. Members who have been here for the whole, or a substantial part of the debate. I understand that the House would like to hear the Minister reply to some of the points that have been raised, so that gives us about 60 minutes before the Minister will seek to catch my eye. The arithmetic is obvious.

Mr. Alan W. Williams: I congratulate the Government on deciding to introduce routine anonymous testing. It is an important and courageous step, which has been advocated for several years.
It is important to establish the prevalence of HIV in this country. We know that there are about 10,000 cases, but some estimates are that the figure is nearer 50,000 and, possibly, 100,000. Anonymous testing will give us information about the regional breakdown of those figures, the age profile and the numbers of men and women infected. It is an important step and will mean that all the resources that are chanelled into public education and local authority support in this epidemic will be used more wisely. It is frightening when one realises the prevalence of the virus. In December, the Minister said that up to 25 per cent. of homosexual men in London have the virus. We have heard that half the drug addicts in Lothian region are HIV positive and that the virus has spread into the general population to the extent that I per cent. of men aged between 15 and 44 carry it.
The Cox report, which was commissioned by the Government, projects that there will be between 10,000 and 30,000 AIDS cases by 1992. That is up to 15 times the present level. It is significant that the estimate is that one third of those will be heterosexual. AIDS has broken into the heterosexual community and once there, its spread will know no bounds.
A news feature in the United States a couple of weeks ago found that, of a sample of 1,100 children, prostitutes and others who live on the streets of New York, 74 were HIV positive. That is 7 per cent. of the total. The Centre for Disease Control in the United States says that, by 1992, a total of 263,000 people in the United States will have died from AIDS. That is just three years away. Some 1·5 million people carry the virus in the United States. They will die of AIDS before the end of the century. We are talking of an epidemic of historic proportions.
I listened carefully to the hon. Member for Fulham (Mr. Carrington) when he spoke about Africa. It is estimated that 15, 20 or even 40 per cent. of the population there carry the virus. The problem is truly heterosexual there. Half the carriers are men and half are women, and most are of working age—the population on which the economy depends. The hon. Gentleman speculated about whether some kind of human resistance might develop. I am pessimistic about that possibility. A study of prostitutes in a district of Nairobi found that 85 per cent. of the 1,000 people tested were HIV positive. In the light of such figures, it is clear that everybody is vulnerable.
The World Health Organisation estimates that 400,000 people will die of AIDS this year and next, and that between 5 million and 10 million are already infected. We have already heard a wealth of statistics, but it is clear that AIDS is the greatest threat to human health this century. That is widely acknowledged to be the truth, so what are we doing about it?


The only real hope—the only chink of light—must come from research work. I was a research scientist and have brothers who are medical researchers. One has been involved in AIDS research. I am, therefore, interested in the size of the Government's budget for research work on AIDS—£7 million this year for the Medical Research Council's directed programme.
AIDS is the greatest threat to human health this century, but how much are we spending on finding a solution? Only £7 million out of an NHS budget of £20 billion. It works out at 0·03 per cent. of our Health Service resources. Frankly, that figure is pitiful.
During the summer, I wrote to the Minister's predecessor, asking for a much greater research effort. The answer was that the Medical Research Council was getting all the funds that it had asked for. I cannot believe that. However, if that is the case, the Government should be proactive and point out their concern to the Medical Research Council and the medical community, and ask the MRC to put much greater emphasis on AIDS research.
Next year, the budget will increase to £14 million. That is a doubling of the allocation, but it is only keeping pace with the spread of the disease. The figure for 1992–93 is £16 million. The figure is doubled for this 12 months, but it will be static after that.

Mr. Mellor: It will go up.

Mr. Williams: I hope that the Minister will take up that point and give me an assurance that, in 1990–92, the budget will at least double every year, in step with the spread of the disease.
The AIDS research budget in the United States is over $1 billion. We should compare our £7 million with the £600 million that is spent in the United States. Their research effort is literally one hundred times greater than ours. Our research effort needs to be stepped up tenfold immediately, and doubled every year in line with the spread of the disease. That is our only ultimate chance of finding a vaccine or improved drugs to slow the progress from HIV to AIDS.
Another main aspect is public education and the Government's efforts in that regard. Two years ago, leaflets were distributed, and there were television and newspaper advertising campaigns. It was on a far too small scale. It is not enough to hit people just once with the message. The message must nag people all the time. Until we find a cure—we may never do so—the only message that we can offer is that people must change their behaviour. For the next 10 years, it will come down to individual behaviour.
We have heard that the public education budget for local authorities is about £14 million. To the ordinary person, £14 million sounds like a lot of money, but when we divide it among our 650 constituencies it works out at £20,000 per constituency. That means that each constituency has the equivalent of one full-time worker trying to stop the greatest threat to human health this century. That is the extent of our defence—just one person per constituency trying to tell young and sexually active people to modify and control their behaviour. Again, it is a case of far too little. When the history of this chapter is written, it will be seen that, as with many environmental problems, our action was too little, too late.
I end by quoting my right hon. Friend the Member for Chesterfield (Mr. Benn), who, in one of our parliamentary

Labour party meetings, said as a throwaway remark that AIDS was a greater threat than the Red army. It is worth dwelling on that remark, because I am persuaded that it is true. Between now and the turn of the century far moire British people will fall victim to AIDS than to the Red army. Our defence budget is £20 billion a year; our research budget for AIDS is £7 million a year. I ask the Government again to start thinking hard about the scale of the problem—and in a proactive way. Politicians think in terms of economic growth of 2 or 3 per cent. a year; if it is as high as 4 or 5 per cent., we lose control, as the Chancellor has done. Unfortunately, AIDS is growing by 100 per cent. a year and seems likely to continue to do so for several years. So we must think in those terms.
I ask the Government to devote 10 times as much money to research, to local authorities and to public education, and to remember the regrettable fact that the budget needs to double every year.

Mr. Barry Field: I look forward to welcoming my hon. and learned Friend the Minister on his first visit to my constituency in his new role. We shall show him many areas of health care on the island. One of the few that receives publicity is the fact that the Isle of Wight is a favourite holiday resort of haemophiliacs. We stock larger quantities of Factor 8 than do most district health authorities. The tragedy of tragedies in all this, as evidenced in this sensitive debate, is what happened to those who received infected donated blood and Factor 8.
The Isle of Wight is not a constituency primarily at risk from AIDS. Representing one of the largest and oldest populations in the country, I suggest that its incidence in our community is low. But we have three prisons. and I promised in my election manifesto that I would campaign for a change in the law to make screening for AIDS compulsory in our prisons. I could not possibly go as far as the hon. Member for Tooting (Mr. Cox) went; he said that no one who seemed to be suffering from AIDS should have to stay in prison any longer. I included the promise in my manifesto not by way of censure but as a helpful contribution to the psychology and running of our prisons.
I pray in aid the report of Her Majesty's chief inspector of prisons on Her Majesty's prison, Parkhurst. It is the only national prison surgical unit in the United Kingdom and receives prisoners needing surgery and treatment from all over the country. The report is dated 30 November 1988, and paragraph 3158 reads:
We recommend that all inmates undergoing surgery should have routine blood assessments for Hepatitis B and HIV. Apart from emergencies, surgery should not be undertaken unless the inmate consented. Failure to observe this in the private hospital sector has already led to successful litigation.
I suggest to my hon. and learned Friend the Minister that that is a clear indication, from the highest level within the prison service, that there are misgivings about the fact that prisoners are not currently being tested for AIDS.
There was a recent tragic case on the island when a person died in Parkhurst prison. I know that it will come as no surprise that the individual was known to be a male prostitute, who was probably HIV positive, but during his time in the prison he would not allow a blood sample to be taken. As a result of his death, which occurred, sad to say, by hanging, it came to light that the Home Office's principal forensic science laboratory at Aldermaston does not have a policy for dealing with HIV positive specimens


which are sent to it. I consider that that is a major omission in the campaign against AIDS and must raise some serious issues about undetected homicide. Of course, death in custody is a serious issue and we should always be sensitive in establishing its cause.
My hon. and learned Friend may tell me that these matters are not for him and his Department. I understand that the island's pathologist declined to carry out a post-mortem and that the director of the forensic science laboratory, Mr. Neylan, entered into quite considerable correspondence with the island's coroner. Mr. Neylan stated that whether samples sent to the laboratory would be analysed depended on a system of volunteers to carry out such work. To say the least, that is an extraordinary state of affairs. However, I take Mr. Neylan's point that, in having to deal with these samples, the individual staff are put at considerable risk over a much longer period than perhaps would normally be the case. It was summed up very well by the coroner when he said:
My personal view of these matters is that it cannot be right to put a life at risk merely to discover why another life has expired.
That is probably a wise comment.
My hon. and learned Friend may suggest that these matters are not for him, but I draw his attention to one particular point. His Ministerial colleagues have a duty to discharge their responsibilities for the collection of information for the Office of Population Censuses and Surveys, and those duties include the registration of deaths and the analysis of the causes. I wonder how the Department can be discharging that duty if the principal authority required to look into the forensic medicine side of pathology is unable to deal regularly with the samples that are sent to it.
As I have said, my call for compulsory testing for AIDS in prisons was not a matter of censure. There are two separate categories of prisons. On the one hand, there is the high security prison, where the prisoner faces a long sentence with no chance of remission or returning to life in the normal world outside, and where feelings and tension can run high from time to time. On the other, there is the low security prison where there is a vast turnover of inmates, who include a high proportion of drug addicts and male prostitutes.
I sincerely believe that the psychological regime in our prisons would be considerably improved if there were a system of compulsory testing of prisoners for AIDS. In the tragic case to which I alluded, the coroner and the staff of the forensic science laboratory would have been in a better position to make a decision had they been able to refer to records, which had been available since the man first entered prison. For that reason I included in my manifesto the commitment for such testing, and I shall continue to campaign for it.

Mr. Harry Cohen: I welcome the debate and I am pleased that the Government have responded favourably by calling it. I requested this debate on 1 December, AIDS Awareness Day. The Government missed the opportunity to use the House on that day to raise the profile of the problems of AIDS, but they have rectified that mistake today.
AIDS is a massive problem, and it will be the single biggest health problem that we face at the turn of the century. Many constructive speeches have been made today and, in common with other hon. Members, I acknowledge that the Government are trying to grope towards tackling some of the difficulties. There are, however, serious gaps in our response to AIDS.
My borough faces a problem because there are no genito-urinary clinics in Waltham Forest. The Minister has already referred to their importance. Because of the lack of such clinics, the number of people in Waltham Forest suffering from AIDS, or, more importantly, those who are HIV positive, is unknown. Because of the absence of those clinics, people are denied the confidentiality and anonymity that they desire before they take such a test. It also means that other sexually-transmitted diseases—for example, venereal disease—are not treated adequately.
Such a clinic is needed because it addresses individuals' fears and helps to allay them. There has been much pressure from the local authority and the community health council to establish a clinic in the borough. The district health authority has responded by saying that it has put in a bid to the North East Thames regional health authority for a clinic. I suspect, however, that the district health authority is using that bid as an excuse for lack of action. We are still awaiting a response from the regional health authority, but we have been waiting a long time. I hope that the Minister will pick up this point and tell the region to get on and supply that clinic. Such clinics are vital, not just to my borough, but to many others.
Testing for AIDS is available in my borough if it is requested by a general practitioner. Many people, however, do not want their GP to know and are worried if their GP finds out that they might be at risk. They cannot ask for an anonymous test because that facility is unavailable.
Waltham Forest borough has appointed an AIDS counsellor who can arrange for such a test. That person also provides counselling before and after the test, which is good. I suspect, however, that that counselling is not widely known about. The borough also employs a co-ordinator who gets the various council departments—housing, social services and environmental health—to work together. He has tried to chivvy up the district health authority. He also has an important training role.
Each AIDS case is expensive. I am told that in my borough the cost is £5,000 per case, and that excludes hospital costs, the costs of the AIDS counsellor and co-ordinator and of training. That is just the basic social services costs. I understand that the national figure is about £27,000. Yet Waltham Forest receives £50,000 from the Government—a small sum which is swallowed up in staffing and covers a bit of the training costs.
The Minister referred to a circular that he has issued and I was notified of the draft
Social Services Specific Grant for services for people with AIDS and related expenditure, Financial Year 1989-90".
I understand that the Government are to provide £7 million to cover anticipated expenditure of £10 million. The remaining £3 million, which the councils must find for themselves, will be subject to all the restrictions of rate support grant cuts and penalties. That is a serious imposition on many London boroughs which are already suffering from problems.
What is worse, I understand that that £7 million will be allocated between two different categories, A and B.


Waltham Forest is left out of both categories and so is not eligible. That is most unfair and brings me back to the problem that we do not have a clinic. We cannot collect proper figures, so the Government have not included us in either category and we cannot get the money. I understand that some county councils which have reported fewer cases than Waltham Forest are in category B.
My borough is similar to many boroughs in category A, let alone category B. For example, Westminster and Hammersmith and Fulham are both in category A. Waltham Forest is also similar to Brent, Ealing, Haringey, Lewisham, and Southwark, which are in category B. As a result, whatever the council spends to deal with the problem will be subject to rate support cuts and penalties. Then the Prime Minister, Ministers at the Department of Health and the ranks of the Tory party will say that we are overspenders. I ask the Minister to consider that local aspect and to review the position.
Many hon. Members have talked about the spread of HIV and AIDS in prison, and rightly so because it spreads from prisons into society. It is a scandal that the Home Office has adopted such a blinkered approach to the problem. Sir Donald Acheson, the Government's chief medical officer, is reported as having said at a world conference on 22 February 1988:
the possible spread of the virus within prisons and after the prisoner was released must be faced.
But apparently the Home Office does not feel that it must face the problem seriously.
We all know that transmission in prisons is mainly by drug misuse and shared needles and by sex with an infected person. A recent report stated that more than 4,000 prisoners who have been released are dependent on drugs, but recognised that the figure could be three times higher than that as many drug users are not in contact with the prison doctor. In 1987, the last year for which I have figures, syringes were found at 13 different prison establishments. In a reply to me, the Home Office stated that the needles were not normally tested for HIV. The Home Office does not want to know. Why not? Why were those needles not tested? The Home Office does not want to know the extent of the problem.
Prison authorities themselves use drugs extensively, often for control and restraint as well as for purely medical purposes. Those syringes could also escape into the prison community. The incidence of unofficial usage must also be recognised. A long-running experiment, carefully controlled and monitored, should be carried out, with clean needles being supplied to avoid shared use. Together with that, prisoners who want to get off drugs should be given counselling. The Home Office has shirked its duty in that respect.
The same applies to sexual transmission of AIDS. We all know that sexual activity occurs in prisons, whatever the rules say. Again, however, the Home Office turns a blind eye to the reality. Condoms are not supplied: they are regarded as contraband. But, as has been said, Spain, Bologna in Italy and New York all supply condoms in their prisons. That surely is a basic, first-step precaution against the spread of AIDS. A similar move in British gaols could be facilitated if, as is done in Spain and Italy, conjugal visits in private were allowed.
I think that the Home Office will eventually pay for its negligence. Sooner or later—if it has not happened already—a prisoner will catch AIDS in prison, and it will be provable. The court will consider the question of blame.

Suppose a prisoner is raped and then catches AIDS. Prison is supposed to be protective custody, yet the negligence of prison authorities will be the issue when the case comes to court. They may well be sued in such cases.
It is not merely a question of money. Society will pay, because the virus will spread from prisons into the community as a whole. The Department of Health should start exerting some muscle over the Home Office. And it is not just the Home Office: many other Departments seem to run the Department of Health ragged on the issue. The Ministry of Defence and the Foreign Office have a poor record on protection of the armed forces. It is a record of complacency. The Ministry of Defence has issued one poorly distributed leaflet to the armed forces. Some of our military personnel are posted in areas where HIV infection is widespread—as high as 70 per cent.—and where prostitution is rife. As far as I am aware, the Foreign Office has made virtually no representations to Governments where those troops are posted—Governments that deliberately cater for prostitution for foreign troops. The Department of Health should demand that the Foreign Office and the Ministry of Defence fall into line with precautionary measures.
The business travelling public are also at risk. While the Department of Trade and Industry can find £50 million for one privatisation project, it has done nothing to warn travelling business men about AIDS. The Department of the Environment keeps cutting local authorities' rate support grant, and that means cuts in care, including AIDS community care. Again the Department of Health has remained silent.
The hon. Member for Fulham (Mr. Carrington) made an excellent speech about Africa, where AIDS is wiping out communities. We live in a small world; that could affect this country. What are the Government doing about the debt problem? The World Bank has reported that, although the Third world paid the First world £43 billion net, because of compound interest it ended up £39 billion more in debt at the end of the year than it had been at the beginning. When countries are shackled like that, how can they tackle their enormous AIDS problem? The Department of Health has made no contribution towards solving it. For all its good efforts, and despite the fact that tentatively it is going in the right direction, the Department of Health is a wimp in its battles with other Departments. It should do something about it.
Sex education in schools should be compulsory so that the lives of our children can be protected. Serious consideration also needs to be given to the introduction of anti-discrimination laws over employment. The Government ought to establish a special insurance fund so that those who contract the HIV virus have access to mortgages. They have a right to be part of the home-owning democracy. They should not be prevented from owning their own homes because of insurance problems.
Community care, above all, is vital. It is right that people should be treated in their own homes. Treatment, however, involves back-up support— almost daily visits from health and social workers and home helps, as well as counselling for families and lovers. It is impossible to provide that support on current funding levels. The Government's dogmatic antipathy to local authorities, particularly Labour authorities that are doing their best to tackle the problem, is retrograde and adds to the problem, and AIDS victims suffer as a result.
There is still a great deal that a responsible Government ought to do to counter the terrible spread of AIDS. If action is not taken, a large proportion of our young people will be wiped out.

Mr. Robert Key: I can think of no area of public policy in respect of which any Government have reordered their priorities as swiftly as have this Government in the face of AIDS. There is a long way to go, but the Government have provided finance swiftly and have set in train a remarkable amount of research.
I have recently visited the poorest parts of Africa, as well as Latin America and Canada—always in connection with development, family planning or AIDS. I have reached two conclusions. The first is that the Government are handling the problem better than any other Government, particularly in helping people to cope with AIDS and in the effectiveness of their public education programme. Money has always been available. The problem has usually been a lack of people to use it. As our ability to use that money improves, more money must be forthcoming and I have no doubt that it will be made available.
Secondly, neither this country nor any other can afford to be xenophobic. AIDS is a pandemic problem. Its significance cannot be overstated. Politicians tend to hyperbole, but the danger on this occasion is that politicians throughout the world will not speak out. That danger is relevant to closed political systems, such as those in the Soviet Union and in China, where there have recently been unpleasant manifestations of xenophobia over overseas students.
The danger is not limited to developing countries with fragile democratic or other systems. It is a feature of the most sophisticated democracies, such as Canada. On a recent visit I was shocked to discover that there are still states in Canada that do not allow AIDS education to be provided in their schools. As a nation that still operates a comparatively open door immigration policy, Canada must face up to the prejudices about immigrants and all foreigners, because of the heightened fear of AIDS. However, it would be an error in Canada, in the United Kingdom or anywhere else to single out immigrants or overseas students. Statistically, their impact is vastly smaller than that of the millions of people who flood into and out of our airports, whether on business or on holiday. Can anyone seriously suggest that in current circumstances every one of those international travellers should be AIDS tested, with all the attendant problems, including the insurance implications?
The pandemic is in its early stages and no one is certain of the number of AIDS cases. The World Health Organisation estimates that there are more than 250,000 AIDS cases, but between 5 million and 10 million people worldwide are probably infected by the virus. Within the next five years, about 1 million new AIDS cases can be expected. The global situation will become much worse before it can be brought under control.
In its most recent publication the Panos Institute stated:
In both its potential for destruction and the dilemmas it poses the HIV pandemic is in a league of its own.

There is no virus vaccine and the quarantine techniques that were used for controlling smallpox, which was eradicated in 1977, is of no use with AIDS because the incubation period is too long.
Poverty is probably the most important co-factor influencing the spread of the AIDS virus. Africa in particular has been afflicted simultaneously by HIV infection and unprecedented economic deterioration. With per capita income lower than in 1980, and a fall of 4 per cent. since 1986, the continent's debt is now three times greater than its export earnings, with no effective relief in sight. The falling prices for African exports have cost African countries nearly $50 billion since 1986.
According to leading British epidemiologists, between 11 and 20 per cent. of the general population of countries such as Kenya, Tanzania, Zambia, and Angola and Somalia are HIV positive. Uganda has the highest reported HIV seroprevalence in Africa, reaching 80 per cent. in high risk groups, including prostitutes, blood recipients, patients with sexually transmitted diseases, the visitors of prostitutes, and partners of any of the above, between 61 and 90 per cent. of such people are HIV positive in Zaire, Uganda, Kenya, Ruanda, and Burundi.
The computer modelling carried out by Professor Roy Anderson of Imperial college and his colleagues suggests that under certain conditions, over a period of decades, AIDS has greater potential to depress population growth rates in developing countries, especially in sub-Saharan Africa and South America than smallpox and bubonic plague in the past.
Therefore, the AIDS pandemic will mean that, even more than in our own country, there will be a huge reduction in the number of young economically productive men and women. That will have considerable economic and social effects on societies that already suffer mass poverty and death from hunger or from simple diseases related to undernourishment. In addition, the present period between infection and the development of AIDS—thought to be eight to nine years—will be reduced in developing countries where people are exposed more frequently to, and to a larger range of, infectious agents than are those in the developed world.
Experts argue that the focus on the number of AIDS cases rather than on the entire spectrum of HIV infection has distorted our understanding of the size of the epidemic. The collection of accurate data has been hindered by political and social sensitivities in developing countries, as well as by under-recognition, under-diagnosis and under-reporting. Experts say that although AIDS is unlikely to affect the ratio of dependants to non-dependants in such societies, the high predicted mortality of AIDS, which requires repeated hospitalisation, perhaps over a period of years, and which is thought to enhance morbidity due to other infections such as TB, will be devastating to already overloaded health care systems in poor countries.
It is impossible to imagine how such health care systems will cope. There is no vaccine in sight and the only hope for arresting the further spread of HIV is the development and forceful application of education programmes that are aimed at changing behaviour. So what are we doing about that in Britain? We are supporting a programme of research into the socio-economic aspects of AIDS. One study will investigate the future demographic and economic impact of the disease. Three others will


contribute to a better understanding of the social contexts which affect the transmission of the virus and the way in which communities cope with the consequences.
First, there is a project at Imperial college, London on the
Analyses of the Demographic and Economic Impact of AIDS on Developing Countries.
It started in August 1987 and will be completed in July 1990. Another project on
Community Coping Mechanisms in Circumstances of Exceptional Demographic Change.
is being carried out by the University of East Anglia. That started in November 1988 and will finish in February 1990. There are a further two projects on key issues in prevention. The first,
A Review of Sources on Social Behaviour in Sub-Sahara Africa
is being carried out by the Sussex university starting in October 1988 and finishing in March this year. Finally a very interesting study on
Traditional Health Practitioners and the Spread of the HIV Virus in Sub-Saharan Africa
is being carried out at Swansea university. That started in July last year and will finish in June this year. That is particularly interesting, because it will assess the methods used by traditional healers in providing health care services in terms of the transmission of the virus and in combating the spread of the disease. Traditional healers may be able to play an important role in campaigns to counter HIV transmission.
The Government have a very good record. The United Kingdom is the largest donor to the World Health Organisation global programme, providing £7·75 million. In addition, we are supporting national AIDS programmes. The United Kingdom contributes to the International Planned Parenthood Federation. Some £1·6 million goes towards helping its public education material. I have seen that operating in Nigeria and the Gambia. It is remarkable to see how effectively one can communicate in such countries and communities, and I commend the IPPF on its work. We also support the European Community AIDS programmes, and our health assistance programme of more than £40 million a year is designed to strengthen developing countries' health services in dealing with the disease.
We simply do not know what will be the economic impact in sub-Saharan Africa, but the United Kingdom has commissioned research which is so important. I listened with interest to what my hon. Friend the Member for Fulham (Mr. Carrington) said about that. Two types of cost will be involved—the direct cost for prevention and patient care, and the indirect costs due to lost output. That is particularly difficult to quantify because we do not know the extent of the epidemic or its effect. Populations may alter significantly, but we do not yet know what will happen. The balance between economically active adults and the dependent young and old may not change because the number of deaths from AIDS among young children may be greater than we first thought and the balance may be relatively undisturbed.
There is much work to be done bilaterally. The Overseas Development Administration is concentrating bilateral assistance on three to five-year, medium-term national AIDS control plans in priority countries and £5·63 million has been pledged in support of programmes

in Uganda, Kenya, Tanzania, Zambia, Zimbabwe. Our support is channelled through the World Health Organisation.
Many people are anxious that the money should be spent in the right way. I believe that it is. In the absence of a cure or vaccine, priority must be given to education and information. However, other priorities that the Government are addressing include protecting blood supplies, laboratory diagnosis, training and surveillance of the progress of AIDS. The Government also offer training on social aspects to developing countries in the form of a one-year post-graduate course leading to a PhD which will equip a person to return and work on the social impact of AIDS in his own country. It is surprising and unfortunate that very few candidates have come forward.
One of the most cynical proposals that I have heard is that we should reduce our overseas aid programme because the AIDS pandemic will eliminate the need for supporting overpopulation. But Malthus was always wrong and AIDS is not a Malthusian crisis. We should reject such arguments and I am very glad that this Government do so; the modest growth in the overseas aid budget next year underlines their commitment.
Above all we must continue to support family planning which brings enormous benefits to mothers and children particularly in developing countries. The idea of a spaced family in a healthy community is good for the menfolk too. I thank the condom manufacturers and pharmaceutical companies for their responsible attitude to the pandemic. I am sure that they have all contributed in their various ways. London International, the makers of Durex, gave substantial sponsorship to the world AIDS conference in this country last year and, together with Roche provided very helpful assistance to the all-party parliamentary group on AIDS.
Without a doubt the United Kingdom is the world leader in recognising and acting on the international dimension of AIDS and I congratulate the Government on that. I have a constituency interest because a great deal of AIDS work is conducted at the public health laboratory service at Porton Down and at its sister establishment in the Gambia. Also, after 40 years the common cold research unit at Salisbury is to shut down. It is a victim not of failure, but of its own success in pioneering work on virology. It is ironic that its distinguished staff, led by its internationally respected director, is putting behind it the impossible quest for a cold cure, but finds itself at the frontiers of knowledge about viruses with a crucial contribution to make in conquering the AIDS virus. The Medical Research Council and the Health Education Authority have also made remarkable efforts to combat AIDS.
This country led the world in public education through media campaigns and direct mail shots. Valuable innovative programmes are now being developed all over the world including in the developing countries. We should not be afraid to learn from them. In particular, there is a remarkable project in Jamaica which has successfully used calypso songs in its education. Of course education need not be drudgery.
Sexual taboos, customs and perceptions do not differ only between races, religions and cultures. Can any hon. Member deny that there are differences of attitude between a Londoner and a Glaswegian, a Yorkshireman and a Welshman, an Ulsterman and a man of Kent? The Government have already announced plans to encourage


local initiatives, but it would make good sense to develop far more public education resources at health authority level. Our district medical officers of health have already shown how they can respond positively. Doctor Armand-Smith of the Salisbury health authority has taken a national lead in many ways in developing local networks.
It is important that we all realise that AIDS is not a bleeding hearts issue. It is one of the toughest problems of the age. It knows no boundaries, but it still rates a low political and parliamentary priority. I noted that none of the hon. Members leading campaigns for or against amending the abortion legislation have been present in the Chamber today. This time next week the Chamber will be packed and the public will be queuing to get into the Public Gallery. Hon. Members will be bombarded with letters and will be lobbied mercilessly by people who feel passionately about abortion. If I am forced to abandon my constituency duties next week, I shall probably be here to vote down a business motion which I consider entirely inappropriate to furthering the cause of the preservation of life and I speak as a moderate supporter of the Bill to amend the abortion legislation. What a contrast next week's debate will be to today's debate, which is also about the preservation of life.

Mr. Toby Jessel: I am very grateful to my hon. Friend the Member for Salisbury (Mr. Key), who has a specialist knowledge of this matter, which he has studied in great depth, for speeding his delivery to allow me to speak for a few moments.
AIDS is becoming a massive threat to life. At its present rate of increase, the number of cases is doubling every 14 months. As a cause of death in Britain, in 1991 it will overtake all other infectious diseases put together, in 1992 it will overtake road accidents, in 1993 it will overtake diabetes, in 1994 bronchitis and in 1995 pneumonia. At the present rate of increase, at some time in the first five years of the next century, it will even overtake cancer as a cause of death, but most of the deceased will be young.
The Minister reminded us earlier that, although AIDS has so far affected mainly homosexuals and drug addicts in Britain, that is not so in Africa. In France, and Belgium the rate of heterosexual infection is twice as great as in the United Kingdom. During last night's Adjournment debate my hon. Friend the Member for Streatham (Sir W. Shelton) spoke of prostitutes in Streatham who are infected with AIDS. All this tends to bear out the fact that the spread of this horrible disease between men and women is increasing.
I congratulate the Minister on the action that has been taken so far, in particular his announcement today. However, we must be more rigorous in finding out who is infected and then curtail their infection of others, whether by persuasion or compulsion. That is much more important than upholding traditional medical ethics, politeness or not hurting people's feelings. We should be motivated by compassion and we should show great compassion and care for those who are ill and soon to die. However, it is at least as important to show compassion to those who may catch the disease as to those who already have it because there are more of them and the disease is incurable.
In relation to AIDS, preventive medicine must be paramount. Blood tests for HIV infection should be stepped up. The Government should draw up a list of priorities. They could start with blood tests on anyone needing an operation on anyone entering hospital as a casualty and on anyone having their blood examined by a doctor for any purpose, including general medical check-ups. When anyone shows up as HIV positive or infected by AIDS after a random check, that information should be passed on. Those categories could later be extended.
Testing for AIDS, which is currently anonymous, should not be so. Doctors should be notified as to which of their patients have the disease and they should officially notify the relevant patients. It should be made a criminal offence for anyone who is knowingly HIV positive or who has AIDS to have sexual intercourse with anyone other than a person who is similarly infected. That may sound tough, but it has the sole object of controlling the spread of this appalling plague.

Mr. Mellor: I apologise for the delay in my rising to my feet, but I thought that my hon. Friend the Member for Twickenham (Mr. Jessel) was merely moving on to his next point. I am grateful to him for sitting down and giving me time to reply.
I hope that this debate has given those hon. Members who are most concerned about the issue the opportunity to state their views. I have a formidable list of points that have been made, only some of which, alas, I shall be able to deal with in the remaining time.
I am grateful to the hon. Member for Peckham (Ms. Harman) for giving up her right to reply.

Mr. Deputy Speaker: Order. The hon. Lady does not have such a right.

Mr. Mellor: In that case, I plead guilty to an excess of chivalry. I am grateful to you, Mr. Deputy Speaker, for your firm and guiding hand on our deliberations. I have the right to speak a second time, though some hon. Members might have wished it otherwise.
I shall deal with some of the points raised and I shall write to the hon. Members concerned about any significant points with which I do not have time to deal. If any hon. Members are still worried that points might remain unanswered, they should let me know.
This has been an enjoyable debate. All hon. Members appreciate the significance of the problem and most were kind enough to suggest, as is only fair, that the Government have made a serious and sustained effort to come to grips with it. Everyone, including myself, has said that more needs to be done. The worst possible case for a Minister in an issue such as this is to be defensive about what has been achieved and what remains to be achieved. We have sought to improve facilities and to gear ourselves up to action in line with the growth of the problem. We have, for example, doubled the resources specifically aimed at AIDS, although that underestimates the full extent of activity.
Year after year, as the problem grows, far more resources will have to be devoted to AIDS. I say to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) that one of the key points is to have the best possible data with which we can go to the Treasury about


resources for the Health Service, for example, and social services in the community. We accept the Cox report as the planning base and we shall rely each year on information for determining what more needs to be done. Data is a management tool and we intend to use it as such.
I enjoyed much of the speech made by the hon. Member for Carmarthen (Mr. Williams). We shall not take the view that the notional budget for the Medical Research Council for 1992 is the final figure. Such matters are kept continually under review and I can assure him that if people from such bodies come forward with credible research proposals there is no question of our saying, "Sorry, that is important work but we don't have the money to do it". Our commitment to AIDS research is such that such valuable work as can be done in this country is being done.
I can agree with much of what was said by the hon. Member for Peckham. However, I must say again, en passant, that these debates—and I hope that there will be more of them—would be better if she could purge what she said of one or two points that strike me as being geared more to twisting a knife in the innards of the Government than to shedding light on the topic. We have enough issues on which to be partisan without having to include this one.
I endorse what was said by the hon. Member for Edinburgh, East (Mr. Strang). Hon. Members should not be partisan, but the Government must not describe every call for improvements or every suggestion of underfunding as partisan. The hon. Lady should reflect on the fact that, although she spoke of the Government feeding a witch hunt on AIDS, no one else has associated themselves with that comment and there is no question of it being true.
I can join the hon. Lady in identifying certain priorities. I, too, deplore the inaccurate press article that she mentioned. I agree that it is important to have proper education about a healthy lifestyle—which must include knowledge about AIDS—in schools. Although that decision lies primarily with the boards of governors, we are doing everything in our power, through the distribution of information packs, the Health Education Authority and the provision of an expert co-ordinator in every education authority, to ensure that the information is put across.
The hon. Lady referred to section 28. Whatever controversy remains on it, the hon. Lady must know that an amendment was accepted to ensure that anything done in schools for the purposes of treating or preventing the spread of disease was not stopped and AIDS was one of the prominent reasons why that was done. The hon. Lady asked about the £131 million. Yes, that is fresh money over and above the amount that the National Health Service asked for specifically, justified to the Treasury and would have received on the basis of the growing threat of AIDS. It would be unacceptable to expect district and regional health authorities—given, especially, how disproportionately the burden falls on certain authorities, as my hon. Friend the Member for Fulham (Mr. Carrington) made clear—to pick up the burden without additional, specified funding. We have put in a bid and obtained for next year double the amount spent this year and we are allocating it as fairly as we can.
The hon. Member for Peckham raised the question of fairness of allocation. This year, the health boards in Scotland have received what they asked for and we know that the provision for England will be doubled, as I said to the hon. Member for Edinburgh, East. No regional health

authority in England has told us that it thinks that the allocation is unfair. Were any to do so, we would consider the matter.
The latest figures that I have show that Lothian health board received £2 million this year in AIDS-related moneys and has 20 full-blown AIDS patients. I do not think that dividing the number of AIDS patients by the amount of money is the best guide to adequacy of funding —there is more to it than that—but that rather crude calculation comes out at £100,000 per patient in Lothian. That figure does not sit too badly with those that the hon. Member for Peckham gave for England. I am anxious, however, not to make debating points, but rather to make points of substance.
It is plain that regard must be had to the provision of housing for people who suffer from AIDS. It is clear that there must be an expansion in community care. We have given assistance to that end through a range of specific sums and also through social work training. During the past 12 months, we have announced grants for social work training. My door is always open to people who want to present ideas for other help that we can provide.
I am convinced that, year on year, a lot more will have to be done. We must evaluate the needle exchange scheme. On a personal note, I am glad, as an advocate of that scheme from the outset, that the report seems to justify many of the views that I held when I was doing the drugs brief at the Home Office. I am glad to see that there have been developments to meet some of the points of which I have been advised and which the hon. Member for Edinburgh, East raised in relation to Scotland.
I understand, for example, that, on 22 December, the Scottish Office announced approval for Lothian health board to extend its needle and syringe exchange facilities. I strongly welcome that. I understand that the Scottish Office has also told health boards that it is prepared to consider any specific proposals for setting up further schemes or extending existing ones. I also understand that work is in hand in regard to drug dependency services in Edinburgh.
I shall draw the attention of my colleague in the Scottish Office to the hon. Members' remarks about the Scottish dimension. I still carry with me, from when I started in the drugs job back in 1983, concern about the problems of sharing equipment in Edinburgh and the message it holds for the rest of us in terms of the virus's ability to spread not just into the drug dependent, community but out, through sexual relations, into the rest of the community and, most horrendous of all, to children.
I strongly agree with the hon. Member for Peckham that it is appalling if children born with the AIDS virus have to live in an institution. We are committed to the idea that such children should be fostered or, if possible, adopted. I hope that the closer one examines that matter the less division there is between us.
The hon. Member for Edinburgh, East mentioned the AIDS (Control) Act 1987 reports. The 1988 reports differed widely in content and format, and so were less useful for national monitoring than is desirable. We aim next year to make them more uniform and to integrate them into NHS planning. If the hon. Gentleman has any further thoughts on that, I should be glad to hear from him.
I very much appreciate the thoughtful and, as ever, distinguished speech made by my hon. Friend the Member for Cheltenham (Mr. Irving). We know that when he says


something nice he really means it. One cannot say that of everybody in this place. I was therefore pleased about what he said about my contribution. I have taken serious account of what he said about prisons. Several other hon. Members also spoke about prisons. I shall ensure that the Home Office is made aware of the views that have been expressed.
I share the frustration felt by the hon. Member for Roxburgh and Berwickshire about the funding of voluntary organisations. I have shared that frustration ever since I have been a Minister. I have not yet found the answer, but that does not mean that I am giving up. He is right to emphasise, time and again, how vital is the work of groups such as the Terrence Higgins Trust. They reach out into communities that Ministers and others cannot reach.
That is why we have provided £400,000 for them this year. It is also why we accept that, from time to time, they will want to spur us on or say that we have got it wrong. I have visited the Terrence Higgins Trust, and I strongly and warmly commend what it does.
My hon. Friend the Member for Lewes (Mr. Rathbone) spoke about London Lighthouse. I, too, have visited that tremendous facility. I suspect that we shall have to have more like it. We put £1·25 million into the capital for it. When I was there, I asked the staff about how soon all the beds would be filled. I was told that they were seeking gradually to bring it in and to commission it; they cannot do it all at once. I have not heard from them, but I would like to be sure that they will write in and let us know if there are any specific problems. My hon. Friend, who always speaks so authoritatively on these matters, also mentioned the advisory council's report.
Time has forced me to omit mention of some matters. Hon. Members might have thought that my speech could not have been any longer, but it could have been. One of the points that I left out was—

It being half past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.

BUSINESS OF THE HOUSE

Ordered,
That, at the sitting on Thursday 19th January, notwithstanding the provisions of Standing Order No. 14

(Exempted business), if proceedings on the Motions in the name of Mr. Secretary Ridley relating to Local Government Finance have not been previously disposed of, Mr. Speaker shall at Ten o'clock put successively the Questions thereon; and proceedings in pursuance of this Order, though opposed, may be decided after the expiration of the time for opposed business.—[Mr. Chapman.]

TRANSPORT (SCOTLAND) BILL

Ordered,
That, notwithstanding paragraph (2) of Standing Order No. 84 (Constitution of standing committees) and the action taken with regard to the allocation of the Bill, and Standing Order No. 95 (Scottish Standing Committees), the Transport (Scotland) Bill though not certified as relating exclusively to Scotland shall be considered by the First Scottish Standing Committee; and that subject to Standing Order No. 85 (Chairmen of standing committees) and paragraph (2) of Standing Order No. 86 (Nomination of standing committees), the Members nominated to serve on that Committee by the Committee of Selection in respect of the Bill shall be Members of the Committee in respect thereof and the Members appointed by Mr. Speaker shall be Chairmen thereof.—[Mr. Chapman.]

PUBLIC ACCOUNTS

Ordered,
That Mr. Henry McLeish and Marjorie Mowlam be discharged from the Committee of Public Accounts and Mr. Jeff Rooker and Dr. John Reid be added to the Committee.—[Mr. David Hunt.]

Mr. Robert Rhodes James: On a point of order, Mr. Deputy Speaker. I do not wish to be misunderstood, but Fridays are private Members' days. In today's debate, which had great relevance, the two Front Bench spokesmen spoke for one hour and six minutes. As a result, many hon. Members were not able to be called or had to curtail their remarks. I register the fact that Back Benchers surely have their rights.

Mr. Deputy Speaker: All those hon. Members who sought to catch the eye of the occupant of the Chair were successful in taking part in the debate. I do not know whether their remarks were curtailed. I hope that Front Bench spokesmen on both sides of the House, particularly Ministers, will have regard to what has been said. The hon. Gentleman reflects a complaint that has been made privately or openly on more than one occasion.

Homelessness (London)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Chapman.]

Mr. Tony Banks: One of the problems in a short Adjournment debate on this subject is the sheer weight of evidence which demonstrates the enormous growth of homelessness, however that is defined, since 1979. Reports abound, and I shall refer to some a little later. Evidence from impartial sources exists by the cartload for anyone who wishes to read it. Unfortunately, the Government largely ignore that information.
I could be accused of many things, but I think that being a fool is not one of them. I realise that rational arguments in this place have no real influence on the Government. But, if I am not a fool, I am an optimist—an optimist against all the odds and, I fear, the evidence. I stand here today as a living embodiment of hopes, foolishness, hoping that, for once, the Minister will throw away the Central Office-inspired departmental brief to which he will refer later and let his heart and compassion hold sway on the crucial subject of homelessness in London—if, indeed, heart and compassion have not become indictable offences in today's Tory party.
The statistics regarding homelessness in London, as elsewhere, are stark, although figures can never do justice to the depth of misery and hopelessness that they portray. In London today, there are 21,000 households, placed by local authorities in temporary accommodation, waiting for a permanent council home—an increase from just 2,500 in 1981. Also, 29,500 homeless families are accepted by councils as in priority need. In 1979, it was less than half that figure. More than 7,000 families are placed by London councils in bed and breakfast hotels. In June 1981, the total was only 900. In my borough of Newham, the number of families in bed and breakfast accommodation stood at 557 in December. Bed and breakfast costs for my borough in 1983–84 amounted to £52,000 a year. In 1987–88, they amounted to £5·5 million a year.
Most council lettings now go to the homeless. The figure has grown from 31 per cent. to 57 per cent. since 1981, while the total number of lettings has fallen. In Greenwich, Bromley and Brent the figure is more than 80 per cent. In some London councils the shortage of homes is so acute that the number of people housed from the waiting list each year has shrunk to single figures. The number of homeless families accepted each year in London has been greater than the number of new council lettings for the past two years, and council lettings have fallen dramatically since 1981. That means that even if councils ignored the pressing needs of people on the waiting list, however ill, and the need to move people from estates that are being modernised, and left everyone in temporary accommodation, there would still not be enough council homes to accommodate those with a right to be housed.
In addition, more than 60,000 people in London are not included in the figures that I have given so far. They, unlike some of those whom I mentioned in the previous statistics, have no chance of a council home—now or in the future. They are the single homeless. It is estimated that 2,000 people sleep rough in central London, 30,000 are squatting, 15,000 are in short-life properties in bad conditions, 10,000 are in direct access hostels and night

shelters, and 7,500 are in bed-and-breakfast hotels in central London—a staggering total of 64,000 people with no homes now or in the future.
The Government's response to all this weight of evidence has been to ignore it or to attack Labour local authorities in London for the alleged extent of their vacant properties and rent arrears. A regular battle has gone on in the House between Government propaganda and the facts. As so often in this place, the propaganda wins—but the facts tell a very different story.
The overall level of council-owned empty properties in London fell again in the year to 1 April 1988, from 27,000 to 23,000—a 15 per cent. drop. In contrast, the boroughs report that the position in the private sector remains the same. The number of empty properties there has remained at a massive 97,000 or thereabouts for the past three years. London councils maintained their record of having the lowest proportions of empty homes—3 per cent. of council homes are vacant, compared with 3·6 per cent. of housing association stock, 5 per cent. of stock owned by other public landlords, including Departments of State, and 5 per cent. of privately owned homes.
These figures come from the annual submissions made to the Department of the Environment for capital resource purposes. Although they provide only a snapshot of the position of housing stock they are a useful indicator of general trends. In case the Minister starts talking about the voids in the London borough of Newham, let me make it clear that the housing investment programme returns that I have show 1,921 voids in Newham. From that number must be deducted the units awaiting demolition, the decanting from the TWA tower blocks in the constituency of my hon. Friend the Member for Newham, South (Mr. Spearing) and other structurally unsound blocks in the borough. So the net void level in Newham is 805—2·7 per cent. of Newham's housing stock. I hope that the Minister will realise that that is the truth and not keep repeating the accusation regularly made from the Dispatch Box that Newham has one of the highest void levels in the whole country.
So often, Ministers in this place take the crude total of households in bed and breakfast and compare it with total local authority empty homes. That is a fatuous and grossly misleading comparison. Not all empty homes are available for letting, as the Minister knows. Some are being let as we debate today; some are awaiting repair, demolition or sale. To make such a crude comparison is as silly as Lord Caithness saying on radio yesterday that the number of dwellings in the United Kingdom equalled the number of families. Such comparisons are meaningless and are no more than cheap debating points.
Similarly, the Government use rent arrears as a crude measure of council managerial efficiency. Local authorities in London have made great efforts to reduce arrears. They must do more. I tell the Minister that the three hon. Members who represent Newham meet the council leadership every month and press it to ensure that the council catches up with rent arrears as much as possible and that empty properties are made available to those who need them. We need no lessons on pressuring our local authorities in London.
The Minister must also realise that most rent arrears are brought about by the financial problems of tenants, not by council inefficiency. Councils' efforts to reduce arrears have been wholly undermined by the Government's social security changes. In April, the


Government slashed £650 million from the housing benefit budget. Nationally, that meant that a million people were forced out of the benefit system altogether. The Association of London Authorities gave me figures for Brent which showed that before April the number receiving housing benefit amounted to 31,000, but that is now down to 23,000. In Southwark, before the April changes, 27,000 council tenants were receiving housing benefit, but that is now down to some 22,000. Those are two of London's poorest areas. The Minister surely must have seen the Association of Metropolitan Authorities' which revealed a 37·5 per cent. average increase in rent arrears since those housing benefit changes in April. The survey covered all authorities—Tory, Labour, Liberal and all other categories.
The category of person hit hardest by those changes has been the single homeless—those for whom no authority has any statutory responsibility. Grants are no longer available to assist people to book themselves into bed and breakfast accommodation—instead they can only apply for a discretionary loan. Supplementary benefit paid in advance has been replaced by income support payable two weeks in arrears. Consequently, people do not have the money to obtain bed and breakfast accommodation or the cash to pay rent for the first two weeks. Voluntary agencies in London, such as the Central London Social Security Advisory Forum, have found that most now are being forced to sleep rough in London's streets. That is an indictment of this country, the Government and our system.
I hope that the Minister has had an opportunity to read the book entitled "True Horror Stories" because it gives the real details. The Minister does not have to take these facts from me—I accept that I am politically biased—but the authors are people who work with the single homeless and can tell the Minister the extent and growing urgency of the problem in London. Those problems of homelessness have been created directly by Government policies—policies which to us seem deliberately designed to harass and intimidate the poor, the vulnerable and the weak.
One does not need to have the gift of second sight to understand the true nature of the present housing crisis in London and elsewhere. It has been caused by a Government who refuse to allow a long-term role for public sector housing. Before the advent of the small-minded, ideological bigotry known as Thatcherism, there existed a political consensus on the central role of the public sector in the provision of affordable rented accommodation. That consensus has now been destroyed, together with the hopes of so many of those who are homeless or living in substandard accommodation. Again, the facts are simple and straightforward and well within the grasp of even the thickest Tory Back Bencher.
In the 1970s, London boroughs were constructing about 25,000 new homes a year—that is now down to 2,000. The Government force local authorites to sell their housing stock and, as a result, 100,000 council units have been sold in London since 1979, but fewer than 30,000 have been added to the stock. Nowadays there is no incentive for councils to build, but if they try to do so the Government cut that off, too, by cutting the housing investment programme allocations. They have done that

in London by a further 26 per cent. for 1989–90, which means that the housing investment programme has been slashed in real terms by 86 per cent. since 1979. One does not need a PhD in housing to understand why we have a housing crisis in London and in this country.
The Government say, as they always do, that the market will provide. Market forces might be efficient enough in the provision of cars, electrical equipment or soapflakes, but they are neither efficient nor just in the provision of housing. They never were and they never can be. The Government are relentless in their determination to force people into the hands of private landlords and owner-occupation. The result is a mounting housing crisis caused by policies based on crude ideology rather than on any rational assessment of the housing need and how to meet it.
There is little long-term comfort for those private tenants in London today facing market rents or, indeed, owner-occupiers facing mortgage repayments hiked up by the Chancellor's interest rate increases. Having listened to the Chancellor talking about the Autumn Statement yesterday, I fully expect him during the year try to remove mortgage payments from retail price index calculations. Before that happens, I expect repossessions through mortgage default to rise dramatically during 1989. Court orders for repossessions in London rose from 1,990 in 1980 to 4,723 in 1987. In England and Wales the figure went up from 16,120 to 49,000 in the same period. That is a fairly dramatic increase, but I am afraid that we have seen nothing yet.
Repossessions are now set to go much higher as many owner occupiers are faced with the annual revision of their mortgage repayments. I believe that local authorities should be allowed to assist those in arrears with their mortgage repayments and make a charge upon the property for doing so. I believe that building societies and banks should consider offering a shared ownership scheme whereby they take back the property and then re-offer it to the original owner on a part-rent part-mortgage basis. Obviously, I believe that they should offer concessionary rates to those who are in difficulties with their mortgage repayments.
I know that many building societies are holding back from repossession at the moment because of the scandal and embarrassment that it would cause for them and for the Government. The Minister should note, however, that it is the insurance companies which give top-up mortgages that are foreclosing on people, so the problem will come to the surface fairly swiftly.
Mortgage lenders should be required to provide money advice initiatives rather like the debt-line service offered by the Shelter Housing Advisory Committee in my constituency. I understand that at present that is the only debt advisory service in London. The mortgage lenders should face up to their responsibilities, because in many cases, they have forced people, with the encouragement of the Government, to overreach themselves. They cannot now walk away from their responsibilities and say that it is all down to the local authorities to mop up the mess. We are aware, however, that it is cheaper to build new homes or take over mortgages than to put people into bed-and-breakfast accommodation.
It would be inequitable to be concerned only with owner-occupiers and ignore the desperate plight of many council and private tenants facing rent arrears. In the end the only conclusion, which surely the Minister must


accept, is that we need to have a supply of affordable accommodation provided in all forms of tenure. If the Government were really concerned about homelessness and the housing crisis they would restore housing benefit levels and throw into reverse all the social security changes that have exacerbated the housing problems of the old, the single homeless and the poor. Above all, they would enter into a partnership with local authorities, building societies, housing associations and the private sector to construct homes in sufficient quantities, in all forms of tenure, at prices affordable at all income levels.
In 1989 it is a scandal that the right to a decent home is not given to everyone in this country. We have the wealth, the expertise and the land, but we lack the political will by by the Government to eliminate homelessness from our country.

The Parliamentary Under-Secretary of State for the Environment (Mr. David Trippier): I am grateful to the hon. Member for Newham, North-West (Mr. Banks), for providing the opportunity for a debate on this topic. Although nationally and in London the numbers of people accepted as homeless under the Housing Act 1985 continue to give great cause for concern, I consider that there are ways of alleviating the high social and financial cost of homelessness.
The numbers of homeless appear, recently, to be levelling off and the great majority were never physically without a home. They were found permanent accommodation, albeit at the expense of others on council waiting lists, but in less housing need. The high numbers reflect, in part, underlying social changes and problems, for example, relationship breakdown—this country's divorce rate is now the second highest in Europe—and young people tending to leave the family home earlier.
The hon. Gentleman will be aware that the Government's primary responsibility in this area lies in providing the appropriate legislative framework and in making resources available to local authorities to assist them in the provision of housing in their area. This includes their statutory duties under the Housing Act 1985 to help all those who are homeless, or threatened with homelessness, and who apply to them for assistance.
The Government fully recognise the very great problem of homelessness. That concern is reflected not only in main housing allocations, which I will come to later, but in the allocation of an extra £74 million additional resources since November, 1987—of which nearly £38 million has been made available to London boroughs—targeted specifically on authorities bearing the brunt of this problem. In London alone this is expected to bring about the reinstatement of more than 2,500 local authority and housing association units and the creation of 800 new hostel bed spaces. The Government are also taking action on a number of fronts to help deal with homelessness.
Accusations are frequently made that the new Housing Act ignores the homeless. That is wrong. The whole thrust of our strategy is to increase choice to all income groups. The hon. Gentleman asked for mixed housing, and that is precisely what we intend to provide. The measures in the 1980 Act laid the foundation stones for that.
First, the Act revitalised the moribund private rented sector and enhanced the role of housing associations and the new housing action trusts. To allow tenants greater

freedom of access to new and alternative landlords will, in addition, bring more choice into the housing market, allowing a better match between tenant and landlord. We have introduced assured tenancies and amended the rules on shorthold—fair rent tenancies in the private rented sector to encourage more private landlords to come forward and thus increase the supply of private rented accommodation available. In 1914 about 90 per cent. of the housing stock in England and Wales was rented from a private landlord. By 1938 the percentage had dropped to 58 per cent. Now it stands at a paltry 8 per cent. Private lettings account for over 30 per cent. of the housing stock in France and over 40 per cent. in Germany. Our housing association movement is central to our new policies since it will be the main provider of additional social housing in the future and is expected to play a major role in tenants' choice. Where tenants' choice transfers take place. local authorities will be able to negotiate nomination rights and, where appropriate, special arrangements for homelessness applicants, with the new landlord as part of the transfer agreement.
The tenants' guarantee will make clear to all approved landlords the responsibilities that they have in helping local authorities meet their statutory obligations on homelessness. HATs will also be able to make a contribution in this area by bringing empty council properties back into use. As major landlords in their designated areas, HATs will be well placed to help the local authority find accommodation for the homeless and to enter into agreements over nominations to HAT dwellings. Housing associations have for years shown the way in helping low-income groups. With the additional resources now available to them, they will be able to offer a wider choice and greater help to local authorities in meeting their statutory obligations to the homeless. In any case, London boroughs are likely to remain as important housing managers at least for the foreseeable future. Their role will be recognised and supported until an alternative system is in place.
Secondly, the Housing Act 1988 also provided the financial basis for a major expansion of the housing association movement. The restructuring of the housing association grant system from April 1989 will allow the maximum use of private finance to supplement available public resources and will make it possible for housing associations to expand significantly their housing programmes.
Thirdly, we are also reviewing the legislation on homelessness in order to ensure that priority on housing is given to those in greatest need, although as yet we are not able to put forward proposals. I am still awaiting sight of the Audit Commission report.
Within the total resources available to them, local authorities set their own priorities for dealing with their housing problems, including homelessness. On 1 November, my right hon. Friend the Secretary of State for the Environment announced that gross provision for capital expenditure by local authorities on housing in 1989–90 would be 13·5 per cent. higher than previously planned. That was the fourth successive year in which it has been possible to increase provision, thanks to the continuing success of our right-to-buy policy. Through the receipts which that provides, local authorities have a growing source of spending power to supplement their capital borrowing. Within these overall resources, local authorities will continue to set their priorities for housing


in their areas, but, where appropriate, I would expect them to continue to give a high priority to the needs of the homeless.
I announced on 14 December 1988 that allocations to local authorities through the Department's Estate Action programme for schemes to improve the management and physical conditions of run-down local authority estates would again be increased. The increase is 36 per cent., to £190 million. The extra resources offered through Estate Action, among other things, assist in bringing empty properties on estates back into use to help the homeless. Nine such London schemes have received assistance so far. The hon. Member for Newham, North West will be aware that his own London borough of Newham has featured notably, and I am glad about that.
In the current year, as well as a basic allocation of £372 million of housing investment resources, the London boroughs will benefit from an addition of £30 million of Estate Action resources. In addition to that borrowing power, London boroughs will be able to supplement their HIP allocations by using capital receipts to an estimated amount of just over £600 million, producing an overall spending power of about £1,060 million.
My right hon. Friend announced on 1 November that gross provision for the Housing Corporation would rise substantially over the next three years: £815 million in 1989–90, £1,036 million in 1990–91 and £1,328 million in 1991–92. Gross expenditure by the Housing Corporation by 1991–92 is planned to be 80 per cent. above the original provision for 1988–89. The corporation's approved programme for next year and provisional plans for the following two years, which I announced on 14 December, should ensure a substantial increase in the provision of houses for rent.
The Housing Corporation allocations are concentrated on housing stress areas located mainly in inner cities, including at least £169 million this year for the 21 stress areas in London. The corporation's priorities include the relief of homelessness, and about a quarter of this year's rented housing programme was allocated for that purpose. Housing associations, especially in areas of serious homelessness, are expected to submit schemes aimed specifically at alleviating those problems. In addition, at my request, the corporation will encourage associations to examine their lettings policy to ensure that priority is given to those in the greatest housing need, especially the homeless, and also to ensure that there is effective liaison at local level with the housing departments of local authorities.
Inevitably there is another side to the balance sheet: the efficiency and effectiveness with which the available resources are being used. In our view, local authorities should make better use of existing stock. It cannot be right

to keep homeless families in bed and breakfast hotels while council stock stands empty. The level of void properties in London remains unacceptable, as does the scale of rent arrears owing to London boroughs.

Mr. Nigel Spearing: My hon. Friend gave the facts.

Mr. Trippier: If the hon. Gentleman had listened carefully to what his hon. Friend the Member for Newham, North-West was saying, he would have heard him admit that the figures were improving. He seemed rather pleased about it. I spend a disproportionate amount of my time speaking to Labour-controlled local authorities, which are constantly trying to impress upon me that their record in turning around the number of voids is improving. In a number of cases it is, but in some it is unacceptable. I draw evidence from the last Audit Commission report, which made it clear that a turn-around time of some two and half weeks would bring a net increase of 20,000 homes on to the market. Of course the hon. Member for Newham, North-West and I are pleased that the position is improving; the point that I am making is that there is still some way to go.
In April 1988 there were 103,000 empty council dwellings nationally, 27,000 of which were in London, representing a small net reduction on previous years. Many could be brought back into use quickly through a programme of basic repairs and—as I have said—through improved re-letting rates. More than 8,500 dwellings had been empty for more than a year. That figure is higher than the 7,800 representing families in bed and breakfast in London at the end of September 1988.
In addition to the voids, there is evidence that up to 10 per cent. of council dwellings in inner London may contain unauthorised occupants. Almost certainly those people are in less urgent housing need than those in bed and breakfast accommodation. It is not good enough for local authorities to be unaware who occupies their stock, and to allow malpractices such as the sale of keys. The oft-quoted but stark figure from the Audit Commission's study of local authority housing management, which I have just released to the House, would mean that a considerable number of houses would be brought on to the market, which would be generally welcomed and would alleviate the problem of homelessness with which we are all familiar.
There is, in our view, no single or simple solution to the problem of homelessness. I have explained the ways in which the Government are taking action. As the hon. Gentleman knows, we are reviewing the position. However, the key to reducing homelessness in London generally lies with local authorities and the optimum use that they can make of their existing housing resources.

Question put and agreed to.

Adjourned accordingly at Three o'clock.